Affiliation Agreements

• Submit the Affiliation Agreement with the application as one continuous document and all 12 pages (Cover Sheet, Affiliation Agreement, Student Addendum) completed correctly. The Practicum/Internship office is unable to combine pages or edit these documents in any way. If the Affiliation Agreement is completed using Adobe Form Fill and cannot be submitted with the Cover Sheet and Student Addendum the student should contact the Practicum/Internship office for further instructions.

Practicum Site Requirements that any site completing an Affiliation Agreement must be aware of:

• Must be a non-K-12 school setting
• Candidates must be able to complete 150 clinical hours (with 40 hours minimum of direct service with clients)
• Potential sites include, but are not limited to college settings, community service boards, group homes, hospitals, counseling agencies, non-profit organizations, and private practice settings, etc.
• A licensed counselor (examples are, but not limited to LPC, LMFT, LCSW, LMHC, Licensed Psychiatrist, Licensed Psychologist, etc.) must be on site to supervise the candidate
• The Practicum site supervisor will assess the candidate electronically via LiveText and verify the hours that the candidate completes during the Practicum placement

Any site requesting an Affiliation Agreement specifically for the School Counseling Internship must contact School Counseling.

The sites listed on the state site lists have previously executed Affiliation Agreements with the Fieldwork Office. However, placement at one of these sites is not automatically approved. Each site must still undergo review and receive approval through the individual student’s application process to ensure it meets all program requirements. Final approval is granted by the Fieldwork Office.

*If a site has questions or concerns about an Affiliation Agreement that our office has on file, wishes to renegotiate, or wishes to receive a copy of the agreement the Practicum/Internship office should be contacted.

For a list of other Practicum & Internship opportunities, refer to our Practicum & Internship Opportunities webpage.

If a site requires the use of their own Affiliation Agreement or if they request to make changes to the standard Liberty agreement, email your Practicum & Internship Office to request that the Practicum and Internship Coordinator reach out to your site. You will need to provide contact information (email address and phone number) for the appropriate contact at your site as well as a brief description of the request.

Any site requesting an Affiliation Agreement specifically for the School Counseling Internship must contact School Counseling.

*Affiliation Agreement negotiations can take months. Extensions will not be granted for Affiliation Agreement negotiations.