Affiliation Agreements
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Requirements
This Affiliation Agreement will be required for all Counseling Practicum, Counseling Internship, Addiction Counseling Internship, Doctoral Practicum, and Doctoral Internship applications.
The Affiliation Agreement is a Legal Contract between the site and Liberty University and must be completed according to specific guidelines before a student’s application can be approved.
The M.Ed. School Counseling program uses the Affiliation Agreement only if the site requires it. Students should familiarize themselves with all information found on this site.
Download the Documents
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.
Site With Previous Affiliation Agreement
If you are applying to a site with a previously Executed Affiliation Agreement on file, you will need to submit the following documents:
- Executed Affiliation Agreement – should obtain this document from the student’s site. If the site does not have a copy on file the student should contact the Practicum/Internship Office
- Schedule A & B (PDF) of Affiliation Agreement (Student Addendum, required for every application)
Site Without Previous Affiliation Agreement
If you are applying to a site that does not have an Executed Affiliation Agreement on file with Liberty University, you will need to submit the following documents:
- Cover Page (PDF) of Affiliation Agreement (required to accompany every agreement)
- Affiliation Agreement (PDF) (must be completed by a representative of the site with the ability to make contracts for the site)
- Schedule A & B (PDF) of Affiliation Agreement (Student Addendum, required for every application)
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.
Instructions
- 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)
School Counseling Students
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.
State Site Lists
The sites found on the state site lists have previously executed Affiliation Agreements on file with the Practicum/Internship office.
Other Affiliation Agreement lists:
*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.
Outside Affiliation Agreements
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.