Practicum Documentation Form - Texas Behavioral Health ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated fields for Last, First, and Middle Initial. Ensure accuracy as this information is crucial.
3. Input your Social Security Number and Date of Birth in the specified sections. This information is necessary for identification purposes.
4. Fill in the name of the agency or organization where you completed your practicum. Remember, one form is required per site.
5. Enter the course number of your practicum/internship as it appears on your graduate transcript.
6. Indicate the university that arranged your practicum and provide the start and end dates of your counseling experience.
7. Document the number of clock-hours for both direct and indirect client counseling contact during your practicum.
8. Select all applicable types of counseling and settings by checking the appropriate boxes provided in the form.
9. Finally, have your practicum/internship supervisor complete their section, including their signature and credentials before submitting.

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