<div class="Section1">
<h2 align="center"><span style="TEXT-TRANSFORM: uppercase; FONT-FAMILY: Times New Roman"><span class="lrg-blk">Counseling 6000: Practicum</span></span><br /><strong><em><span style="FONT-SIZE: 26pt"><span class="med-blk"><span class="med-blk">Application & Contract Agreement</span></span></span></em></strong></h2>
<h2 align="center"><span style="FONT-SIZE: 13pt"><span class="med-blk">Lackland AFB and Brooks City Base<br />San Antonio, Texas</span></span><br /><span style="FONT-WEIGHT: normal; FONT-SIZE: 15pt; FONT-FAMILY: Times New Roman"><span class="med-blk">2006 - 2007</span></span></h2>
<p class="MsoTitle" align="center"><span class="sm-blu"><strong><em><span style="FONT-SIZE: 13pt">General</span></em></strong> <em><span style="FONT-SIZE: 13pt"><strong>Information and</strong> <strong>Procedures</strong></span></em></span><br /><strong><em><span style="FONT-SIZE: 13pt"><span class="sm-blu">The Counseling Practicum</span></span></em></strong></p>
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<p class="MsoTitle">The Practicum is a experience in which the student provides counseling services to live clients in a mental health setting under the supervision of a licensed mental health counselor/practitioner. A new student should begin immediately exploring the availability and type of practicum site desired for their long term professional goals: agency setting, private practice setting, etc. </p>
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<p class="MsoTitle">After preliminary contacts by the student, she/he should have narrowed the list of possible sites. The student should then arrange an interview at the agency in which she/he would like to do a practicum. <a href="http://www.irissoft.com/uwsa">The United Way of San Antonio maintains a searchable database of agencies</a>. In this interview, the student should discuss the practicum requirements with that agency. (NOTE: These requirements/responsibilities are outlined in the document, <em>COUN 6000</em> <em>Counseling Learning Practicum, Application & Contract Agreement)</em> <strong><em>It is the students' responsibility to secure a Practicum site.</em></strong></p>
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<p class="MsoTitle">Once a student and the Practicum Site Supervisor have agreed upon the specifics of a Practicum Proposal, the student must submit copies of the signed Practicum Proposal to the <em>Webster Practicum Supervisor <strong>prior</strong></em> <strong>t</strong>o the first class meeting. (NOTE: A Practicum Proposal is not to be accepted unless both the student and the Practicum Site Supervisor sign it<strong><em>.) The Practicum should NOT be the student?s ordinary employment.</em></strong></p>
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<p class="MsoTitle">The Practicum Site Supervisor accepts the responsibility for providing a student with the individualized supervision consistent with the requirements/responsibilities that are outlined in the <em>COUN 6000 Counseling Learning Practicum, Application & Contract Agreement</em>. As also outlined in that document, the student?s supervisor is responsible for reporting on the student?s performance to the Webster Practicum Supervisor.</p>
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<p class="MsoTitle">The Webster Practicum Supervisor is responsible for establishing evaluation procedures with the Practicum Site Supervisor. These procedures may include weekly or periodic updates on the student?s performance, site visits, etc. Although the Webster Practicum Supervisor determines a final grade, the Practicum Site Supervisor is required to provide a formal letter of evaluation of the student at the completion of the practicum. <strong><em>The student will also have liability insuranc</em></strong>e<span style="text-decoration:underline;">. The Practicum Site Supervisor, Webster Practicum Supervisor and agency will also have such coverage.</span></p>
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<p class="MsoTitle">Since the <em>COUN</em> <em>6000</em> <em>Counseling</em> <em>Learning</em> <em>Practicum</em> courses require many hours, the student may need to have the Practicum experience last for more than the normal nine-week term. The Webster Practicum Supervisor will work out an arrangement with the student for completing the course after the term ends.</p>
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<p class="MsoTitle">The direct supervision of a student?s Practicum must comply with state licensure requirements for the type of license that is sought. More specifically, a Practicum Site Supervisor should possess appropriate credentials such as: LPC, LMFT, LCSW, Licensed Psychologist, or Board Certified Psychiatrist.</p>
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</ol>
</div>
<div class="Section2">
<p class="MsoHeading7" align="center"><span style="FONT-SIZE: 14pt; TEXT-TRANSFORM: uppercase; FONT-FAMILY: Times New Roman"><span class="med-blk">COUN 6000: Counseling Learning Practicum</span></span></p>
<p class="MsoHeading7" align="center"><span class="sm-blu"><span style="FONT-SIZE: 13pt; FONT-FAMILY: Times New Roman"><span class="sm-blu">Responsibilities of the Webster Practicum Supervisor</span></span></span></p>
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<p class="MsoHeading7" align="left">Approve students for registration and placement in the Practicum. </p>
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<p class="MsoHeading7" align="left">Endorse the student?s Practicum contract for the designated term.</p>
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<p class="MsoHeading7" align="left">As far as practical, arrange seminars and conferences for students in the Practicum in order to provide feedback, to give support and direction, and to determine opportunities for professional growth, as well as other counseling experiences.</p>
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<p class="MsoHeading7" align="left">Assign grades after consultation with the On-site Supervisor. Grades to be assigned are CR for credit or I (I = Incomplete). A CR means that the contract requirements have been completed. Incompletes will be made up before nine weeks have passed during the subsequent semester and after a student and the <em>Webster Practicum Supervisor</em> have agreed on a written contract to fulfill the requirement, a contract that is to be placed in the student?s permanent file.</p>
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<p class="MsoHeading7" align="left">Visit with the On-site Supervisor(s) at least one time during the semester. Maintain regular contact with the On-site Supervisor(s) by telephone and/or additional visits.</p>
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</ol>
<p class="MsoHeading7" align="center"><span style="FONT-SIZE: 13pt; FONT-FAMILY: Times New Roman"><span class="sm-blu"><span class="sm-blu">Responsibilities of the Counseling Student</span></span></span></p>
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<p class="MsoHeading7" align="left">Meet or talk with the <em>Webster Practicum Supervisor</em> in order to get permission to enter the practicum and to discuss possible sites.</p>
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<p class="MsoHeading7" align="left">Complete the <em>Practicum Application</em> (APPENDIX A, Practicum Form 1) and return to the <em>Webster Practicum Supervisor</em>. One copy will be placed in your permanent file. </p>
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<p class="MsoHeading7" align="left">Read and sign the <em>CONTRACTUAL AGREEMENT BETWEEN PRACTICUM STUDENT AND WEBSTER UNIVERSITY</em> (APPENDIX B, Practicum Form 2) and return to the <em>Webster Practicum Supervisor.</em> This should be submitted with the <em>INTERNSHIP APPLICATION</em> and again, one copy will be placed in your permanent file.</p>
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<p class="MsoHeading7" align="left">Reasonable effort will be made to honor student requests regarding Practicum placements. The <em>Webster Practicum Supervisor</em> will make the final decision on placement. Sites, which offer the greatest breadth of opportunity, most direct client, contact hour opportunities, and best-qualified supervision will take priority.<a href="http://www.irissoft.com/uwsa"> The United Way of San Antonio maintains an up to date searchable database of agencies.</a></p>
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<p class="MsoHeading7" align="left">After you have been notified that your placement has been approved, arrange an initial interview at the Practicum site with your On-site Supervisor. At that time, give one copy of your resume to your On-site Supervisor and mutually decide on goals for your practicum. Be sure to emphasize to your On-site Supervisor that you need a minimum of 150 hours of experience during the term.</p>
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<p class="MsoHeading7" align="left">Submit a <em><strong><a href="http://licensedcounselor.tripod.com/Practicum_Schedule.htm">Practicum Schedule</a></strong></em> to your <em>Webster Practicum Supervisor</em> prior to the first week of the semester and plan to attend all orientations and seminars related to the Practicum course and site.</p>
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<p class="MsoHeading7" align="left">On-site Supervisors are requested to meet with Practicum students a minimum of one hour for each ten clock-hours, but some may choose to meet more often. At least half of these hours must involve individual supervision.</p>
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<p class="MsoHeading7" align="left">The <em>Webster Practicum Supervisor</em> will meet a minimum of one individual supervision session during each semester with each student. Depending upon the skill level demonstrated and other relevant factors, the student and the <em>Webster Practicum Supervisor</em> may decide to meet more frequently.</p>
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<p class="MsoHeading7" align="left">Typically, your <em>Webster Practicum Supervisor</em> is the person with whom you should consult regularly. Also, check carefully the course outline and/or syllabus for pertinent details. It is your responsibility to complete all of the requirements that are listed in your Practicum syllabus.</p>
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<p class="MsoHeading7" align="left">It is your responsibility to follow all of the instructions and to provide all of the information required in executing the steps outlined in this packet, including those intended for your designated On-site Supervisor. Please be sure that you fully understand all of your responsibilities at the outset and if clarification is necessary, ask questions of a Counseling coordinator and/or your <em>Webster Practicum Supervisor</em>.</p>
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<p></p>
<p class="MsoHeading7" align="left"><strong><span style="FONT-SIZE: 13pt"><span class="sm-blu">Responsibilities of the On-Site Supervisor</span></span></strong></p>
<p class="MsoNormal">The following guidelines provide useful information to students and supervisors about the intended nature of the Practicum and about the responsibilities of the professional personnel, especially the On-site Supervisor, who are directly involved.</p>
<p class="MsoNormal">1. Regular supervision is essential to the success of the Practicum.</p>
<p style="MARGIN-LEFT: 45pt; TEXT-INDENT: -13.5pt" class="MsoNormal">a. The Webster <em>Practicum Supervisor</em> will contact each On-site Supervisor during the semester. Regular contact with the On-site Supervisor will be maintained by phone and/or additional visits</p>
<p style="MARGIN-LEFT: 45pt; TEXT-INDENT: -13.5pt" class="MsoNormal">b. The <em>Webster Practicum Supervisor</em> is available upon request at any time should the need arise..</p>
<p style="MARGIN-LEFT: 45pt; TEXT-INDENT: -13.5pt" class="MsoNormal">c. Each student will participate in an ongoing analysis or Practicum group seminar with the <em>Webster Practicum Supervisor</em></p>
<p style="MARGIN-LEFT: 13.5pt; TEXT-INDENT: -13.5pt" class="MsoNormal">2. The student is instructed to contact the agency, or institutional supervisor at least one week prior to the beginning of the semester to arrange hours, orientation sessions, deliver a resume, and to discuss and to decide on goals and a time plan for the semester.</p>
<p style="MARGIN-LEFT: 13.5pt; TEXT-INDENT: -13.5pt" class="MsoNormal">3. During the semester, a student is expected to spend a minimum of 150 clock hours on site.</p>
<p style="MARGIN-LEFT: 13.5pt; TEXT-INDENT: -13.5pt" class="MsoNormal">4. On-site Supervisors should arrange for students to take part in staff meetings and staff/in-service training.</p>
<p style="MARGIN-LEFT: 13.5pt; TEXT-INDENT: -13.5pt" class="MsoNormal">5. The student should be given the opportunity to practice individual, group, and/or family counseling in order to demonstrate counseling skills and to receive feedback on his or her performance.</p>
<p style="MARGIN-LEFT: 13.5pt; TEXT-INDENT: -13.5pt" class="MsoNormal">6. On-site supervisors are requested to suggest to the student readings relevant to that particular site. These readings may be books, articles, manuals, or related materials the On-site Supervisor believes to be most helpful to the student in understanding better the site and/or the clients, which it serves.<span style="FONT-SIZE: 12pt; FONT-FAMILY: Times New Roman"> </span></p>
<p style="MARGIN-LEFT: 0.25in; TEXT-INDENT: -0.25in" class="MsoNormal">7. The student is expected to follow consistently the policies, professional activities and procedures, and legal responsibilities of the agency or institution.</p>
<p style="MARGIN-LEFT: 0.25in; TEXT-INDENT: -0.25in" class="MsoNormal">8. On-site Supervisors are requested to complete a mid-semester and a final evaluation of a student?s performance. See the <em>ON-SITE SUPERVISOR EVALUATION</em> (APPENDIX D, Practicum Form 4).</p>
<p style="MARGIN-LEFT: 0.25in; TEXT-INDENT: -0.25in" class="MsoNormal">9. The final evaluation and grading of a student?s performance is the responsibility of the <em>Webster Practicum Supervisor</em>, but only after receiving direct, written input from the On-site Supervisor. It is the responsibility of the <em>Webster Practicum Supervisor</em> to initiate contact with the On-site Supervisor in order to establish specific criteria and procedures for evaluation of the student?s performance.</p>
<p style="MARGIN-LEFT: 0.25in; TEXT-INDENT: -0.25in" class="MsoNormal">10. The student is required to complete a <em>STUDENT EVALUATION OF PRACTICUM SETTING</em> (APPENDIX E, Practicum Form 5) of his or her Practicum which should include, but is not limited to, a discussion of learning outcomes; how to integrate these outcomes into practice; strength and limitations of the site; an analysis of the total field experience and seminar, as well as supervision; and learning from the On-site Supervisor?s assigned readings and on-site activities. A copy of this review is to be shared and discussed with the On-site Supervisor; another copy goes to the <em>Webster Practicum Supervisor</em>; and the student retains one copy.</p>
<p style="MARGIN-LEFT: 0.25in; TEXT-INDENT: -0.25in" class="MsoNormal">11. The On-site Supervisor is requested to provide input to the Counseling degree program at Webster University. Input may include, but is not limited to, feedback on the curriculum; competence or skill levels acquired as reflected in student performance; and skills or issues that could be added to the program.</p>
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<p style="MARGIN-LEFT: 0.25in; TEXT-INDENT: -0.25in" class="MsoNormal">The Counseling degree program at Webster University greatly appreciates the professional input and participation of On-site Supervisors in the training of its students. The ultimate success of that training is assured when the On-site Supervisor?s input and participation is maximized. We thank you in advance for your cooperation and collaboration.</p>
<span style="FONT-SIZE: 12pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: always" /> </span>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><strong><span style="FONT-SIZE: 14pt">APPENDIX A</span></strong></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em><span style="FONT-SIZE: 13pt">(Practicum Form 1)</span></em></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><span style="text-decoration:underline;">Student Practicum Application</span></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em>(A copy of this form will be returned to you after your site has been approved)</em></p>
<p class="MsoNormal">This Application must be filled out completely and returned to a Counseling coordinator at least one term prior to the one in which the Practicum is to take place. Indicate starting term and year:</p>
<p class="MsoNormal"> Spring I_____ Spring 2______ Fall I______ Fall 2 ______ Summer__________</p>
<p class="MsoNormal">Student Name:_________________________________ Phone:___________________________</p>
<p class="MsoNormal">Address:________________________________________________________________________</p>
<p class="MsoNormal">Briefly describe your special areas of interest in the field of Counseling. What would you like to accomplish in the Practicum experience?</p>
<p class="MsoNormal">Is there a particular agency or setting in which you want to do your Practicum? If so, where?</p>
<p class="MsoNormal">Are you currently employed in the agency, school, institution, or setting mentioned above?</p>
<p class="MsoNormal">Is there any other information (e.g., previous experience), which you believe may be beneficial to the On-site Supervisor?</p>
<p class="MsoEndnoteText">Student Signature: _________________________________________Date: _________________</p>
<p class="MsoNormal">Webster Practicum Supervisor Signature: _____________________________ Date: ________________</p>
<p class="MsoNormal">Practicum Site: __________________________________ Phone: _________________________</p>
<p class="MsoNormal">Address: _______________________________________________________________________</p>
<p class="MsoNormal">Site Supervisor: ________________________________ Contact Phone: ____________________</p>
<strong><span style="FONT-SIZE: 12pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: always" /> </span></strong>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><strong><span style="FONT-SIZE: 13pt">APPENDIX B</span></strong></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em>(Practicum Form 2)</em></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><span style="text-decoration:underline;">CONTRACTUAL AGREEMENT BETWEEN</span></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><span style="text-decoration:underline;">PRACTICUM STUDENT AND WEBSTER UNIVERSITY</span></p>
<p class="MsoNormal">(A) I hereby attest that I have read and understand the LPC and/or LMFT Codes of Ethics (<a href="http://www.dshs.state.tx.us/counselor/default.shtm" style="COLOR: blue; TEXT-DECORATION: underline; text-underline: single">http://www.dshs.state.tx.us/counselor/default.shtm</a> / <a href="http://www.dshs.state.tx.us/mft/" style="COLOR: blue; TEXT-DECORATION: underline; text-underline: single">http://www.dshs.state.tx.us/mft/</a>)</p>
<p class="MsoNormal"> I will practice my counseling in accordance with these standards. I further understand that any breach of this code or any unethical behavior on my part will result in my receipt of a failing grade in the Practicum and written notification of such behavior will be placed in my permanent record</p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">(B) I understand that all students must carry professional liability insurance. Attached is a photocopy of my insurance.</p>
<p class="MsoNormal">(C) I understand that it is my responsibility to keep my Practicum supervisors (On-site Supervisor and Webster University Instructor of Record) fully informed regarding my Practicum experience.</p>
<p class="MsoNormal">(D) I understand that I will not be awarded a passing grade until I have demonstrated in the Practicum a specific minimal level of Counseling knowledge, skills, and attitudes.</p>
<p class="MsoNormal">(E) I further understand that it is my responsibility to attend all classes and supervisory sessions fully prepared as outlined in the Practicum course requirements. If any sessions are not attended, or attended without my full preparation, they will not be counted toward the fulfillment of the minimal Practicum requirements.</p>
<p class="MsoNormal">Student Name: __________________________________________</p>
<p class="MsoNormal">Student Signature: _______________________________________ Date:________________</p>
<span style="FONT-SIZE: 12pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: always" /> </span>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><strong><span style="FONT-SIZE: 14pt">APPENDIX C</span></strong></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em><span style="FONT-SIZE: 13pt">(Practicum Form 3)</span></em></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><span style="text-decoration:underline;"><span style="FONT-SIZE: 14pt; TEXT-TRANSFORM: uppercase">Webster University</span> STUDENT ACCEPTANCE CONTRACT</span></p>
<p class="MsoNormal">________________________________________________________________ Agrees to accept</p>
<p class="MsoNormal"> (Agency, school, institution)</p>
<p class="MsoNormal">________________________________________________________________, A graduate</p>
<p class="MsoNormal"> (Print student name)</p>
<p class="MsoNormal">Student in the Counseling degree program at Webster University, as a student counselor. All parties have read the Counseling Practicum information packet and accept the responsibilities described therein.</p>
<p class="MsoNormal">Practicum Beginning Date: _____________________ Ending Date:______________________</p>
<p class="MsoNormal">Name of On-site Supervisor: ______________________________________________________</p>
<p class="MsoNormal">Signature of On-site Supervisor: ___________________________________________________</p>
<p class="MsoNormal">Contact Phone Numbers: _________________________________________________________</p>
<p class="MsoNormal">Name of Student Counselor: ______________________________________________________</p>
<p class="MsoNormal">Signature of Student Counselor: ___________________________________________________</p>
<p class="MsoNormal">Contact Phone Numbers: _________________________________________________________</p>
<p class="MsoNormal">Name of <em>Webster Practicum Supervisor</em>:_____________________________________</p>
<p class="MsoNormal">Signature of <em>Webster Practicum Supervisor</em>:__________________________________</p>
<p class="MsoEndnoteText">Contact Phone Numbers: _________________________________________________________</p>
<p class="MsoNormal">Date:________________________________</p>
<strong><span style="FONT-SIZE: 11pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: always" /> </span></strong>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><strong><span style="FONT-SIZE: 14pt">APPENDIX D</span></strong></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em><span style="FONT-SIZE: 13pt">(Practicum Form 4)</span></em></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><span style="text-decoration:underline;">ON-SITE SUPERVISOR?S MIDTERM & FINAL EVALUATION FORM</span></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center">Webster University Counseling Program</p>
<p class="MsoNormal">To the On-site Supervisor: Please have the student check the appropriate space below and sign and date before you complete your evaluation.</p>
<p class="MsoNormal">I waive__________ do not waive__________ my right of access to this evaluation.</p>
<p class="MsoNormal">Student Name:____________________________________ Date:______________________</p>
<p class="MsoNormal">Student Signature:_________________________________</p>
<p class="MsoNormal">Your Name:______________________________________ Date:______________________</p>
<p class="MsoNormal">Your Signature:___________________________________</p>
<p class="MsoNormal">Site Supervisor?s Evaluation of This Student (attach additional pages as necessary):</p>
<span style="FONT-SIZE: 12pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: always" /> </span>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><strong><span style="FONT-SIZE: 14pt">APPENDIX E</span></strong></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em><span style="FONT-SIZE: 13pt">(Practicum Form 5)</span></em></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><span style="text-decoration:underline;"><span style="FONT-SIZE: 14pt; TEXT-TRANSFORM: uppercase">Webster University</span> PRACTICUM STUDENT SITE EVALUATION</span></p>
<p class="MsoNormal">NOTE: This form should be completed by the student and given to the <em>Webster Practicum Supervisor</em> at the conclusion of the Practicum experience at a given setting.</p>
<p class="MsoNormal">Student Name:____________________________________ Term & Year:______________</p>
<p class="MsoNormal">Practicum Setting:______________________________________________________________</p>
<p class="MsoNormal">On-Site Supervisor's Name:_______________________________________________________</p>
<p class="MsoNormal">In order to assist other students in choosing a Practicum setting, please comment briefly on your experience as a student in each of the following areas (attached additional pages if necessary).</p>
<p class="MsoNormal">1. Describe the Practicum setting</p>
<p class="MsoNormal">2. Describe the type of clients with whom you worked and the problems which they had.</p>
<p class="MsoNormal">3. Describe the type of counseling/professional activities, which were available to you as a student.</p>
<p class="MsoNormal">4. Describe the facilities and resources, which were at your disposal.</p>
<p class="MsoNormal">5. Describe the type and level of communication among the counselors with whom you interacted.</p>
<p class="MsoNormal">6. Describe the type and level of supervision you received.</p>
<p class="MsoNormal">Please provide any additional comments (e.g., on the advantages and/or disadvantages of this particular setting) you think might be helpful to other students who might be considering this or a similar Practicum setting.</p>
<br /><br /> <br /><br /> </li>
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</div>
<span style="FONT-SIZE: 11pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: right" /> </span>
<div class="Section3">
<p class="MsoHeading8"><span style="FONT-SIZE: 13pt; FONT-FAMILY: Times New Roman">APPENDIX F</span></p>
<p style="TEXT-ALIGN: center" class="MsoNormal" align="center"><em>(Practicum Time Log)</em></p>
<p style="LINE-HEIGHT: 150%" class="MsoNormal">Practicum Student: _________________________________</p>
<p style="LINE-HEIGHT: 150%" class="MsoEndnoteText"> Facility: _________________________________</p>
<p style="LINE-HEIGHT: 150%" class="MsoNormal"> Site Supervisor: _______________________________</p>
<p style="LINE-HEIGHT: 150%" class="MsoNormal"> <em>Webster Practicum Supervisor</em>: _______________________</p>
<table border="1" style="BORDER-RIGHT: medium none; BORDER-TOP: medium none; BORDER-LEFT: medium none; BORDER-BOTTOM: medium none; BORDER-COLLAPSE: collapse" class="MsoNormalTable" cellspacing="0" cellpadding="0" id="table1">
<tbody>
<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67">
<p style="MARGIN-TOP: 6pt; TEXT-ALIGN: center" class="MsoNormal" align="center">Date</p>
</td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432">
<p style="MARGIN-TOP: 6pt; TEXT-ALIGN: center" class="MsoNormal" align="center">Brief Description of Counseling activity</p>
</td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66">
<p style="MARGIN-TOP: 6pt; TEXT-ALIGN: center" class="MsoNormal" align="center">Time In</p>
</td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66">
<p style="MARGIN-TOP: 6pt; TEXT-ALIGN: center" class="MsoNormal" align="center">Time Out</p>
</td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66">
<p style="MARGIN-TOP: 6pt; TEXT-ALIGN: center" class="MsoNormal" align="center">Total Time</p>
</td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 1pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162">
<p style="MARGIN-TOP: 6pt; TEXT-ALIGN: center" class="MsoNormal" align="center">Supervisor?s Signature</p>
</td>
</tr>
<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
</tr>
<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
</tr>
<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
</tr>
<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
</tr>
<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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<tr>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1pt solid; WIDTH: 0.7in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="67"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.5in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="432"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 49.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="66"></td>
<td valign="top" style="BORDER-RIGHT: windowtext 1pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 121.5pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1pt solid" width="162"></td>
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</tbody>
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<span style="FONT-SIZE: 11pt; FONT-FAMILY: Times New Roman"><br clear="all" style="PAGE-BREAK-BEFORE: always" /> </span>
<p style="TEXT-ALIGN: center" class="MsoEndnoteText" align="center">APPENDIX G</p>
<p style="TEXT-ALIGN: center" class="MsoEndnoteText" align="center"><em>(Practicum Debriefing Log)</em></p>
<p style="LINE-HEIGHT: 150%" class="MsoNormal">Intern: __________________________________ Date: ________________</p>
<p style="LINE-HEIGHT: 150%" class="MsoEndnoteText">Facility: _________________________________</p>
<p style="LINE-HEIGHT: 150%" class="MsoNormal">Site Supervisor: _______________________________</p>
<p style="LINE-HEIGHT: 150%" class="MsoNormal"><em>Webster Practicum Supervisor</em>: _______________________</p>
<p class="MsoBodyText"><span style="FONT-SIZE: 12pt; LINE-HEIGHT: 150%; FONT-FAMILY: Times New Roman">Counseling Objective: ____________________________________________________________</span></p>
<span style="FONT-SIZE: 12pt; FONT-FAMILY: Times New Roman">Brief description of the day or counseling session:</span>
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