Forms
Forms and Timelines
|
|
Completed By |
Given To |
When
|
|
Advising Sheet |
Advisor and student |
Program Director |
At entrance to program |
|
Assessment Instrument Presentation Rubric |
Seminar Instructor |
Student |
After presentations of (1) cog/acad and (2) projective assessments in Seminar |
|
Attainment Grid |
Seminar Instructor |
Program Director |
At completion of internship |
|
Case Study Design and Plan |
Student |
Practicum/Seminar Inst. |
Before beginning data collection for each CS during Practicum I and Internships |
|
Case Study Permission |
Student/Parent |
Practicum/Seminar Inst. |
Before beginning data collection for each CS during Practicum I and Internships |
|
Case Study Rubric |
Practicum/Seminar Inst. |
Student and file |
After revision of each CS during Practicum I and Internships |
|
Change of Level Form |
Students who complete the MEd portion and are entering the Ed.S. portion of the program |
Program Director |
September 5th for the fall semester, February 5th for spring/ summer |
|
Consultation Feedback Form |
Parent or Teacher |
Field Supervisors |
During Practicum I and Internships |
|
Counseling Case Notes |
Student |
Field Supervisors |
During Internship |
|
Counseling Permission |
Student |
Field Supervisors |
During Internship |
|
Counseling Treatment Plan |
Student |
Field Supervisors |
During Internship |
|
Degree Application |
Students planning to obtain M.Ed. or Ed.S. degree end of semester |
Program Director |
September 5th for the fall semester, February 5th for spring/ summer |
|
Employer Agreement Form |
Incoming students |
Program director |
Upon program entrance |
|
Field Supervisor Tuition Voucher Request Form |
Student |
University Supervisor |
Each semester—by October 1 in fall, by March 1 in spring |
|
Fourth statement of personal growth |
Information/sample |
|
|
|
Grad Assistantship Application |
Student |
Administrative Assist. |
At program entrance (or later) |
|
Incomplete Contract |
Faculty and student |
Program Director |
At student’s receipt of Incomplete for any class |
|
Inservice Presentation Rubric |
Seminar Instructor |
Student |
After presentation |
|
Intern Contract |
Student, Field Supervisor, Field Administrator, University Supervisor |
Program Director |
After successful interview and placement agreement is reached |
|
Intern Evaluation |
Student and Field Supervisors |
University Supervisor |
Reviewed mid term; submitted at the end of each semester |
|
Internship Application |
Student |
Program Director |
Before applying for internship |
|
Internship Contact Questions |
University Supervisor |
(Informational) |
|
|
Internship Site Information Form |
Student |
Program Director |
End of placement at each field site |
|
Journal Assignment |
Student |
Seminar Instructor |
Weekly during internship |
|
Log (Practicum and Intern) |
Student and Field Supervisors |
University Supervisor |
Each semester |
|
Log (Practicum and Intern)(Sample) |
Information: Download Internship Log |
|
|
|
Meeting Observation |
Field supervisors and University Supervisor |
Student |
After meetings during Practicum/ Internship |
|
Observation Rubric |
Field supervisors and University Supervisors |
Student |
After on-site observations in Practica and Internship |
|
On Line Tools |
Information |
|
|
|
Out-of-state knowledge of Massachusetts Frameworks-student |
Students completing internships out of state |
Include in portfolio |
At end of internship |
|
Out-of-state knowledge of Massachusetts Frameworks-student |
Seminar instructors for students completing internships out of state |
Program director |
At end of internship |
|
Practicum Application |
Student |
Program Director |
When applying for Practicum I or II |
|
Practicum Contract |
Student, Field Supervisor, Field Administrator, University Supervisor |
Program Director |
After successful interview and placement agreement is reached |
|
Practicum Student Evaluation Form |
Practicum student, Field /University supervisors |
University supervisor |
Reviewed mid term; submitted at the end of each Practicum |
|
Pre-Practicum Log |
Student and Field Supervisor |
Instructors in courses requiring Pre-practicum hours (e.g. SPY 601), then Program Director. |
At completion of hours |
|
Presentation Evaluation |
Recipients |
Seminar instructor |
After presentations |
|
Preservice Performance Assessment Cover Sheet |
University Supervisor |
Licensure Officer |
End of internship |
|
Program Evaluation Form |
Student |
Program director |
After graduation |
|
Psychoed Report Rubric |
Seminar Instructor |
Student |
Upon completion of each psychoed report |
|
Psychoed Report Template |
Information |
|
|
|
Site Description Rubric |
Seminar Instructor |
Student |
After Site Description received |
|
Supervision Log (Practicum and Internship) |
Student and Field Supervisors |
SPY 688 University Supervisor |
Each semester |
|
Supervision Conference Questions |
University Supervisor |
Informational |
|
|
Team Meeting, running |
Information |
|
|
|
Testing Observation |
Field supervisor and University Supervisor |
Student |
After observing testing during Practicum II and Internship |
|
Third Statement of Personal Growth |
Information/Sample |
|
|
|
Transfer Credit Approval |
Student and Program Director |
Registrar |
After official transcript of approved course is received |
Program Director: Terry Bontrager, Ph.D. at terry.bontrager@umb.edu