Affiliation Agreements

The Practicum/Internship office cannot accept duplicate Affiliation Agreements, so students should first check to see if their site has a previously Executed Affiliation Agreement with Liberty University by asking their site and checking the state site lists below. For sites with multiple locations, Liberty only needs one agreement with the site.

Any questions regarding the Affiliation Agreement should be directed to the Practicum/Internship office.

Confidentiality and Terms of Use

Permission is granted to use the above Affiliation Agreement with student’s proposed Affiliate(s) and for no other purpose. By downloading the Affiliation Agreement, the student agrees that he/she shall not reproduce, distribute, post, or disclose the contents thereof with any person or entity, or in any medium, including, but not limited to websites or apps, online forums, blogs, discussion boards, or social media sites. These terms are governed by the Student Code of Conduct.

• 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.
• Provide the Instructions (PDF) to complete the Affiliation Agreement to the site along with the blank Affiliation Agreement template
• Read the Practicum/Internship Office’s Guidelines (PDF) for the Affiliation Agreement

Sample Affiliation Agreement (PDF) (this sample agreement will not be accepted if used as a template)

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 found on the state site lists have previously executed Affiliation Agreements on file with the Practicum/Internship 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.