School counseling intern request form 10-29-09
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09-10 School Counseling Intern Request Form
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School counseling intern request form 10-29-09
- 1. School Counseling Intern Request Form Please fill out this form and save the file to your desktop, Then email form to tyra_bob@lacoe.edu or fax to (562) 922-6299. Name of School: ____________________________________________________________________________ Address: __________________________________________________________________________________ Our counseling program is addressing the National Standards/National Model: Yes_____ No_____ Nature of Project/Assistance: ___________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Student contact: Yes_____ No_____ Fingerprinting required: Yes_____ No_____ Start date/End date: __________________________________________________________________________ Numbers of hours weekly/monthly: _____________________________________________________________ Bilingual graduate student needed/language/s: Yes _____ No_____ Language/s: _________________________________________________________________________________ Can use more than one graduate student/how many: Yes_____ No_____ How many? _____ Is this a paid or unpaid internship? Paid_____ Unpaid_____ Name of school counselor/administrator who will supervise the candidates: ______________________________ ____________________________________________________________________________________________ Phone number: ____________________________________ Email: _________________________________ ********************************************************************************************* Please note that LACOE, Student Support Services, will disseminate your request on our Access Network list serve. Due diligence with regard to implementing the internship rests with the school district and the university (i.e. defining the internship and oversight responsibilities, conduct required, optional background checks).