ࡱ> ?A>{ bjbjzz 4>>>>>RRRRfR0|zzzzzUZ$^V>UU>>zzsss >z>zssssz0 s00sBs>s(s1B0 : AGREEMENT BETWEEN DEPARTMENT OF COUNSELOR EDUCATION AND COUNSELING PSYCHOLOGY (CECP) AT MARQUETTE UNIVERSITY AND COOPERATING AGENCY: __________________________________________ Address __________________________________________ __________________________________________ Telephone __________________________________________ FOR THE CONDUCT OF A SUPERVISED COUNSELING PSYCHOLOGY PRACTICUM The above named agency agrees to provide the facilities, student work opportunity, instruction, and supervision necessary to properly conduct a counseling practicum experience for the student named below and according to the guidelines described in the Department of Counselor Education and Counseling Psychology Handbook for Counseling Practicum (COPS 8965) and the Clinical Affiliation Agreement. Name of Practicum Student _______________________________________________ Inclusive Dates of Practicum ______________________ # Credits/Semester ____ Agency Director _______________________________________________ Signature Date *Supervising Psychologist _______________________________________________ Signature Date _______________________________________________ Supervisors Printed Name Practicum Student _______________________________________________ Signature Date Director of Training CECP տƵ _______________________________________________ Signature Date *Please attach a copy of the Primary Supervisors Vita and License/Certification 34UXmoL M R ! " % @ q C U V o p    9 : F ` a 󢖆xkȢ_h~ch~c6OJQJh~chesOJQJaJh~ches5OJQJaJh~ches5OJQJ\aJh~ch~c5OJQJh~ches6OJQJh~chesOJQJ\h~ches5OJQJ\h~chesOJQJh~ches5>*OJQJh~c5OJQJhw45OJQJh~ches5OJQJ%Vos Q R ! 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I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] a  :  8@0(  B S  ? _Toc359575629 _Toc359575630 _Toc359575631q 3488UXmossLMRR!"@@pp  CCTUVV9:``Az3488UXmossLMRR!"@@pp  CCTUVV9:``Azvw4~ces@@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial7.@ CalibriK,Bookman Old StyleA$BCambria Math"h  r0KqHP  $Pes0!xx  local admin local adminOh+'0$3x   ( local adminNormal local admin2Microsoft Office Word@@|@|G1VT$m   !1.@Times New Roman------ %2 =>0 AGREEMENT BETWEEN      2 =0    2 ^` 0 DEPARTMENT OF     2 ^0   (2 ^0 COUNSELOR EDUCATION      2 ^0   2 ^0 AND  72 ^0 COUNSELING PSYCHOLOGY (CECP)        2 ^0    2 ~)0 AT   2 ~>0   )2 ~B0 MARQUETTE UNIVERSITY      2 ~0    2 ~ 0    2 0 AND   2 0    (2 `0 COOPERATING AGENCY:     2 0    2 0  0 J2 P*0 __________________________________________  2 0     2 `0  0  2 0  0 2 0 Address   2 0  *  2 0  0 J2 P*0 __________________________________________  2 0     2 `0  0  2 0  0  2 0  0  2 0  0  2  0  0 C2 P%0 _____________________________________ 2 b0 _____  2 0     2 "`0  0  2 "0  0 2 " 0 Telephone   2 "0    2 " 0  0 D2 "P&0 ______________________________________  2 "j0 _ 2 "q0 ___  2 "0     2 C`0   @Times New Roman--------- j2 dl?0 FOR THE CONDUCT OF A SUPERVISED COUNSELING PSYCHOLOGY PRACTICUM              ---  2 d0  @Times New Roman------- @ !Xfl- --- 2 `d0 The above named agency agrees to provide the facilities, student work opportunity, instruction, and     82 `0 supervision necessary to prope q2 D0 rly conduct a counseling practicum experience for the student named     2 `]0 below and according to the guidelines described in the Department of Counselor Education and        2 `_0 Counseling Psychology Handbook for Counseling Practicum (COPS 8965) and the Clinical Affiliatio          2 0 n   2 ` 0 Agreement.    2 0   ---  2 `0    0' 2 `0 Nam   42 ~0 e of Practicum Student    R2  /0 _______________________________________________  2 |0    0'  2 4`0   --- 52 T`0 Inclusive Dates of Practicum     2 T0   ,2 T 0 ______________________  2 T0   &2 T0 # Credits/Semester  ---  2 TY0   2 T\0 ____  2 T{0   ---  2 v`0   --- "2 `0 Agency Director  --- 2  0    2 0  0 R2  /0 _______________________________________________  2 |0   @Times New Roman--------- 2 ` 0   R2 /0  --- 2 1 0 Signature  2 m0    2 0  0  2 0  0  2 0  0 2 0 Date   2 .0   ---  2 `0   @Times New Roman------@Times New Roman--------- 12 `0 *Supervising Psychologist   2 0  --- R2  /0 _______________________________________________  2 |0    0'---  2 `0    2 d0  , /2 0   2  0   2 0  --- 2 1 0 Signature  2 m0    2 0  0  2 0  0  2 0  0 2 0 Date   2 .0   ---  2 `0  0  2 0  0  2 0  0  2 0  0  2  0   R2 $/0 _______________________________________________  2 0    2 0   ------  2 `0  0  2 0  0  2 0  0  2 0  0 2  0  ---  2 /0   12 20 Supervisors Printed Name     2 0   ---  2 `0    0' 2 =` 0 Practicum St   (2 =0 udent  2 = 0    2 =#0   R2 =&/0 _______________________________________________  2 =0    0'--- a2 O`90  --- 2 O1 0 Signature  2 Om0    2 O0  0  2 O0  0  2 O0  0 2 O0 Date   2 O.0   ---  2 d0   --- )2 u`0 Director of Training    2 u0    &2 `0 CECP տƵUni   2 0 versity 2 0   R2 +/0 _______________________________________________  2 0    0'--- a2 `90  --- 2 1 0 Signature  2 m0    2 0  0  2 0  0  2 0  0 2 0 Date   2 .0   ---  2 0   --- 2 P0 *Please attach a copy of the Primary Supervisors Vita and License/Certification        2 h0   "Systemwj w@wr j --  00//.._` ՜.+,0 hp  տƵ   Title Headings  !"#$%&'()*+,-./012345789:;<=@Root Entry FB1Table WordDocument4SummaryInformation(T3DocumentSummaryInformation86CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q