This Handbook may serve as a guide, but students should adhere to the TCU Graduate Catalog and information obtained from their academic advisor. Last updated December 2018 MASTER’S DEGREE COUNSELING PROGRAMS STUDENT HANDBOOK Master of Education in Counseling Texas Christian University Fort Worth, Texas 76129
38
Embed
MASTER’S DEGREE COUNSELING PROGRAMS2u3yf82pgfnx3wajn4bul3ve-wpengine.netdna-ssl.com/... · Solution-Focused Brief Therapy by Mo Yee Lee, PhD The Counseling Program at TCU upholds
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
This Handbook may serve as a guide, but students should adhere to the TCU Graduate Catalog and
information obtained from their academic advisor. Last updated December 2018
MASTER’S DEGREE
COUNSELING PROGRAMS
STUDENT HANDBOOK
Master of Education in Counseling
Texas Christian University
Fort Worth, Texas 76129
Contents
Letter to the Students ………………………………………………………………………………...………………………….1
Overview of the Counseling Program ........................................................................................................................................ 2 Mission...................................................................................................................................................................................... 2 Philosophy ................................................................................................................................................................................ 2 Administration ......................................................................................................................................................................... 3 Accreditation ............................................................................................................................................................................ 3
Assessment of Counseling Dispositions and Skills ..................................................................................................................... 6 When are Student Dispositions and Skills Assessed? ........................................................................................................... 6 What is the Disposition and Skills Assessment Process? ...................................................................................................... 6 Student Disposition Appeals ................................................................................................................................................... 7
Programs of Study ........................................................................................................................................................................ 7 M.Ed. Programs of Study ....................................................................................................................................................... 7
Professional Liability Insurance ............................................................................................................................................... 13
Professional Counseling Organizations .................................................................................................................................... 13
School Counselor Credentialing................................................................................................................................................ 14 Testing for School Counselor Certification ......................................................................................................................... 14
Licensed Professional Counselor (LPC) Credentialing .......................................................................................................... 15 Steps to applying for licensure: ............................................................................................................................................ 15
Campus Services......................................................................................................................................................................... 16 Learning Environment .......................................................................................................................................................... 16 Financial Assistantships and Resources .............................................................................................................................. 16 Mary Couts Burnett Library ................................................................................................................................................ 16 Technical Support ................................................................................................................................................................. 17 TCU Counseling and Mental Health Center ....................................................................................................................... 17 Writing Center ....................................................................................................................................................................... 17
Policies and Procedures ............................................................................................................................................................. 18 Transfer Credit ...................................................................................................................................................................... 18 Academic Conduct, Warning, and Appeals ........................................................................................................................ 18 Professional Behavior Standards ......................................................................................................................................... 19 Violations ................................................................................................................................................................................ 19
Forms and Documents ............................................................................................................................................................... 20
Practicum Application and Related Forms ......................................................................................................................... 21-28
Field Experience in Student Affiars (FESA) Application and Related Forms................................................................. 29-36
1
This Handbook may serve as a guide, but students should adhere to the TCU Graduate Catalog and
information obtained from their academic advisor. Last updated December 2018
TCU Box 297900
Fort Worth, TX 76129
817. 257.7661
Dear Students:
Congratulations and welcome to the TCU Counseling program!
The Master of Counseling Program Student Handbook is designed to inform students about various
aspects of the program from start to finish. As such, we provide information about the program, required
classes throughout the program with required pre-requisites, practicum/internship/field experience, and
requirements for degree candidacy.
The M.Ed. Counseling program is continually working to make improvements to maintain a program that
is the most educationally beneficial to our students; therefore, changes to the Student Handbook are
ongoing and any updates will be distributed to students via e-mail from the Counseling Program faculty.
Any changes will be implemented upon notification. Our goal is to create a program that offers
meaningful educational experiences to help create ethical and competent counselors.
If you have any questions after reviewing the Student Handbook, feel free to contact counseling core
faculty or Lori Kimball at [email protected] for more information. We work to create an environment
where students feel supported and are willing to assist students through their educational journey and
This Handbook may serve as a guide, but students should adhere to the TCU Graduate Catalog and
information obtained from their academic advisor. Last updated December 2018
Assessment of Counseling Dispositions and Skills As prospective counselors, you are expected to represent the college as professionals and adhere to the
ethics and standards of the counseling profession. In addition to the College’s Student Code of Conduct,
professional dispositions and necessary skills apply to all students in the TCU Counseling Program. The
dispositions address affective attributes and general dispositions attributed to a counselor. The skills
address skills related to the knowledge and application of solution focused brief therapy (SFBT). The
Assessment of Counseling Dispositions and Skills rating form provides insight on what dispositions and
skills will be assessed. Please refer to the Assessment of Counseling Dispositions and Skills Rubric for
further guidance.
Upon entry to the program, students will be introduced to professional dispositions, as well as the
procedures for assessment of dispositions and skills. During New Student Orientation, students will be
provided information for accessing the Assessment of Counseling Dispositions rating form and rubric
(available in the Student Handbook and on the Counseling Program website).
When are Student Dispositions and Skills Assessed?
Dispositions for Counseling Program students are assessed at the conclusion of the following courses:
• EDGU 50223, Helping Relationships
o The Professional Dispositions and Skills procedure will be reviewed in EDGU 50223.
Students will complete the self-assessment at the beginning of the course.
o At the conclusion of EDGU 50223, the counseling faculty will assess professional dispositions
and skills for each student using the Assessment of Counseling Dispositions and Skills Rubric
and will record these ratings on the Assessment of Counseling Dispositions and Skills form.
• EDGU 50323, Small Group Dynamics
o The Professional Dispositions and Skills procedure will be reviewed in EDGU 50323.
Students will complete the self-assessment at the beginning of the course.
o At the conclusion of EDGU 50323, the counseling faculty will assess professional dispositions
and skills for each student using the Assessment of Counseling Dispositions and Skills Rubric
and will record these ratings on the Assessment of Counseling Dispositions and Skills form.
NOTE: In addition to these courses, students’ dispositions and skills will be assessed annually by core
counseling faculty.
What is the Disposition and Skills Assessment Process? 1. Counseling core faculty meet, as a group, to assess each candidate’s dispositions and skills and
complete the assessment forms. If the student received a 1 or 2 rating, indicating the student is
below expectations, the counseling core faculty may propose a recommendation which should be
noted on the rating form.
2. At least one core faculty member will review the Disposition and Skills Rating Form with the
student after the completion of faculty assessment.
3. Students will sign the rating form indicating they have reviewed their ratings with a faculty
member and agree to the ratings and recommendations, if applicable. If the student does not agree
with the recommendation and wishes to appeal, information regarding the appeal process is below.
7
This Handbook may serve as a guide, but students should adhere to the TCU Graduate Catalog and
information obtained from their academic advisor. Last updated December 2018
Student Disposition Appeals
A student has the right to appeal the decision and recommendations of the core counseling faculty. The
recommendations appeal must be made to the core counseling faculty within ten (10) business days of the
review meeting when student received information about the program decision and recommendations.
The counseling core faculty committee shall review the case and provide the student with an opportunity
to speak on his/her behalf. The counseling core committee may interview any stakeholders including, but
not limited to, faculty or staff who have previously assessed or provided documentation of past
dispositions. After reviewing all documentation, and interviewing all relevant parties, the counseling core
faculty will deny or accept the appeal, with or without conditions.
Programs of Study
M.Ed. Programs of Study Those seeking the M.Ed. in Counseling have three options:
1. School Counseling
2. Student Affairs
3. Clinical Mental Health Counseling
All specializations are designed to provide students with the necessary counseling skills and external
resources to provide individual, preventive, responsive, and support services to counseling programs.
School Counseling (36 credit hours)
(may move to 48 credit hours pending changes in TEA rules)
The M.Ed. in School Counseling meets the requirements of the Texas State Board of Educator
Certification and follows the guidelines for certification in school counseling. If students choose
the school counseling specialization, they must pass the practice TExES exam before taking the
state exam for counseling in schools. All counseling classes may also be applied to Texas
professional licensure.
Click to view program of study: Specialization I: School Counseling
EDUC 60323 Assessment in Counseling
EDUC 70953 Research in Education
EDUC 50143 Theories of Human Development
EDGU 50223 Helping Relationships
EDGU 60003 Counseling Diverse Populations
EDGU 60233 Career Development and Information
EDGU 50323 Small Group Dynamics
EDGU 60143 Counseling Interventions
EDGU 60383 Counseling Theories and Techniques
EDGU 60613 Orientation to Programs in Guidance and Counseling Programs
EDGU 70103 Practicum I
One 3-hour counseling elective: Pre-practicum is highly
• Do not turn in this application until you have all components. • Electronic delivery is not appropriate – place printed copies in the Practicum Coordinator (Dr.
Becky Taylor) faculty box: Copy Room, 3rd floor, Palko Building, College of Education TCU • KEEP A COPY FOR YOUR OWN RECORDS • Keep this for your records – do not turn this Checklist in with your Application
DATE COMPLETED
TASK
Complete Application for Practicum Form
Brief description of proposed site completed. This should be 1-3 pages, single spaced, and must include:
• Job Description – what responsibilities you will assume, obligations to the site
• Proposed Clinical Supervisor • Proposed Site Administrator • Days/Hours you are obligated to be at this site (minimum
of 10 hours per week) – give exact days and times you will be present at the site
Secure Clinical Supervisor materials and complete the “Supervisor Approval Request Form”:
• copy of State of Texas license/certification, with expiration (where applicable)
• contact information • agreement signed and dated (must be signed and dated
for the semester you are seeking for Practicum)
Secure Site Administrator materials: • Site Administrator agreement signed and dated
Secure malpractice insurance – proof of purchase and policy
information showing your name, dates of coverage, and policy limits required
Complete TCU-COE FERPA Waiver
Complete Assumption of Risk Form (Submit the first page. Keep the second page.)
COMPLETE Application delivered to the Practicum Coordinator (Dr. Becky Taylor)
22
APPLICATION FOR PRACTICUM (EDGU 70103, Practicum I)
Counseling Program, TCU College of Education If you wish to enroll in EDGU 70103, Practicum I, all required materials must be turned in to the Practicum Coordinator (Dr. Becky Taylor) by the following deadlines: Fall Practicum: April 15 Spring Practicum: November 15 The following must be submitted as a hard copy by the deadline (no electronic copies):
1. This completed application form 2. Proof that you have current malpractice insurance. This must be a photocopy of the actual policy
showing coverage limits and start/end dates of coverage. Sources from which you can secure this insurance:
a. Texas Counseling Association http://www.txca.org
b. American Counseling Association: https://www.counseling.org/membership/aca-and-you/students https://www.hpso.com/
c. American School Counselor Association: https://www.schoolcounselor.org/school-counselors-members/member-benefits-info
3. From your proposed supervisor: State of Texas license/certification, contact information, signed and dated agreement to meet requirements as a supervisor for your practicum (attached). Note: At least one of your proposed sites MUST allow you to video record counseling sessions (in English).
4. From your proposed site administrator: signed and dated agreement stating that the administrator approves of your assignment (attached).
5. A brief description of your proposed site, including job description, proposed counseling supervisor, administrative supervisor, and days/hours you are obligated to at this site.
6. Complete the TCU “Assumption of Risk” form (see checklist for links) and FERPA Consent to Release Educational Records and Information.
Obligations: Practicum I and Practicum II require the following of you:
• Class attendance and participation: about 3 class hours per week. • Minimum of 160 practicum hours, at least half of which must be client contact hours • Progress notes for each client contact. • Two case presentations with illustration (in English) of solution-focused counseling approach. • Arranging site visit for professor or other supervisor contracted by TCU. • Other obligations as stated in the professor’s class syllabus.
Note: Additional requirements for Practicum I students include the following:
• Completion of formal oral presentation of skills. (graduation requirement) • Passing an ethics examination covering American Counseling Association (ACA) ethics (see the
• Students who wish to pursue School Counseling track MUST complete 160 hours at public K-12 school site for counselor certification during Practicum I. Site supervisor must be a Texas certified school counselor. Students on this track also must pass the TeXES school counselor practice examination. Do you plan to pursue school counselor certification? ____ Yes ____ No
Name: ____________________________________ TCU Email: ____________________________________________ Phone: (_____)___________________ Cell phone: (_____)___________________ Mailing Address: ______________________________________________________________ Street City, State, ZIP
SUPERVISOR APPROVAL REQUEST FORM Counseling Program, College of Education
Texas Christian University Student: ___________________________________ Semester: Fall Spring 20____ (circle one) Dear Colleague: Thank you for your willingness to supervise a student for our program. In order to supervise the student who has approached you to be his/her Practicum Supervisor, all of us – supervisors, faculty, and students – need to be in agreement regarding requirements and expectations. The process has the following steps:
1. The student secures the following documents and information from you by the filing deadline: a. current licensure and/or certification status b. contact information, including email and phone numbers c. a signed and dated agreement to meet requirements as a supervisor for this practicum
student (attached) 2. Any questions you have regarding these requirements should be sent via email to the
Practicum Coordinator, Dr. Becky Taylor ([email protected]), prior to the deadline (April 15 or November 15). We commit ourselves to responding in a timely manner, knowing that your time is valuable.
3. The Counseling faculty meets to review both the student’s Practicum application and the information you have provided to determine if the site, job description, and proposed supervisor meet the standards of the Program. If there are questions about the application, a member of the Counseling faculty will contact the proposed supervisor during this review period.
4. Approval or rejection of the application is sent to the student and to the proposed supervisor by email.
All supervisors must meet the following requirements:
1. Provide one (1) hour of one-to-one supervision per week during the semester, a minimum of 15 total hours.
2. Provide opportunities for counseling and video recording of a minimum of three (3) clients during the course of the semester, for supervision and course use only.
3. Be available to the student for emergencies involving client harm to self or others and other issues that may involve legal or ethical concerns.
4. Show support for student’s use of a solution-focused approach to counseling. 5. Complete evaluation forms by the semester deadlines (midterm and final) and maintain
monthly communication with TCU faculty practicum instructor regarding the student’s progress. 6. Maintain personal malpractice insurance OR be employed by an ISD or other employer who
provides coverage. 7. Assist student in arranging site visit. During site visit, practicum instructor (or other designated
counselor contracted by TCU) will visit the student at his or her site, meet with site supervisor,
24
and observe the student working with a client or clients (student should obtain client’s assent prior to day of site visit).
Activities this student should be exposed to and allowed to lead (under your supervision) include (but are not limited to): small groups, guidance activities (large group education and facilitation), co-leadership, co-counseling, individual counseling, crisis intervention, parent education, and parent counseling. If you agree to these requirements, please sign and date this form. You should keep a copy and the original should be given to the student, who will submit it with the application packet. VIDEO RECORDING: please initial one of the following two options: ______ The student will be allowed to video record her/his sessions after securing appropriate
releases from clients (or parent/guardians) only for use in the TCU Practicum class and supervision by TCU faculty.
______ The student will not be allowed to video record at this site, but practicum instructor will
be allowed opportunity for live observation on site. I agree to supervise the student named above for the semester listed on this form. I have read and agree to meet the standards detailed on this form. ___________________________________ ________________________________ Signature Print Name ______________________________________________________________________ Site Name ______________________________________________________________________ Site Physical Address (NOT PO Box) City, State, ZIP ___________________________________ Email ___________________________________ ____________________ Daytime Phone Date
*Have you supervised TCU counseling students in the past? �Yes �No Note: Please attach copy of license that allows you to practice (e.g., CSC, LPC, LCDC).
25
SITE ADMINISTRATOR APPROVAL REQUEST FORM Counseling Program, College of Education
Texas Christian University Student: ___________________________________ Semester: Fall Spring 20____ (circle one) Dear Colleague: The student named above is seeking permission to work at your facility to meet the requirements for “Practicum” (EDGU 70103 or EDGU 70203) at TCU. By signing this document, you agree that the student has your permission to complete work that includes direct client contact (including actual counseling services) at this facility to meet class requirements. Any questions you have regarding these requirements should be sent via email to the Practicum Coordinator, Dr. Becky Taylor ([email protected]), prior to the application deadline (April 15 or November 15). We commit ourselves to responding in a timely manner, knowing that your time is valuable. This student has my permission to work at the facility named below for the semester listed on this form. ___________________________________ ________________________________ Signature Print Name ___________________________________ ________________________________ Title Email ___________________________________ ________________________________ Facility Name Date
26
Texas Christian University College of Education
FERPA Consent to Release Educational Records and Information
This release represents your written consent to permit Texas Christian University, College of Education to disclose educational records (as noted below) and any information contained therein to the school and other agency officials with legitimate educational interests. Further, without such a release, I am unable to participate in any field-based experiences including hours of observation, clinical teaching, practicums, student teaching, or internships. This consent covers the entire student career at TCU unless revoked in writing by the student. Please read this document carefully and fill in all blanks.
I, ______________________________________________________ [print full name] am a candidate at Texas Christian University, College of Education and hereby give my voluntary consent: A. To disclose the following records:
• Records relating to any of my field-based experiences • Records relating to my performance in the field • TExES test score results in aggregate
B. To the following person(s):
• School districts or other agencies associated with field-based experiences • School-based/Agency-based administrators • School-based/Agency-based cooperating teachers/mentors • Program faculty
C. These records are being released for the purpose of:
I understand that under the Family Educational Rights and Privacy Act of 1974 (“FERPA” 20 USC 123g; 34 CFR §99; commonly known as the “Buckley Amendment”) no disclosure of my records can be made without my written consent unless otherwise provided for in legal statutes and judicial decisions. I also understand that I may revoke this consent at any time (via written request to the TCU College of Education and the TCU Registrar’s Office) except to the extent that action has already been taken upon this release. ___________________________________________ ________________________________ Signature of Candidate Date ___________________________________________ ________________________________ TCU ID Number TCU Email
TEXAS CHRISTIAN UNIVERSITY
INFORMED CONSENT AND ASSUMPTION OF RISK
IMPORTANT – READ ENTIRE AGREEMENT BEFORE SIGNING
Texas Christian University is a non-profit educational institution. References to Texas
Christian University include “TCU”, its trustees, officers, officials, employees, volunteers,
students, agents, and assigns.
I (print your name)___________________________________________________
Signature of Parent or Legal Guardian (if minor) Date
In Case of Emergency, Notify: Name ______________________ Cell ______________________ Home ______________________
Office ______________________
27
jbosillo
Highlight
jbosillo
Highlight
jbosillo
Highlight
jbosillo
Highlight
jbosillo
Highlight
jbosillo
Highlight
jbosillo
Highlight
Safety Guidelines Suggestions For Your Safety Off-Campus…
Walking to and from your car…
• Have entry/ignition keys in hand before starting for your car so you’re not trying to find them
while you walk to the car or standing at the car door.
• Stay alert when crossing the parking lot and watch for suspicious persons.
• If you have a cell phone, have it within easy reach
• Even if your car was locked when you left it, check the interior prior to entry for uninvited
guests.
• If a stranger approaches you, continue walking to your car, politely decline requests for
money or information. Don’t stop walking toward your car.
• If asked for help, offer to call the police or suggest they return to the business. DO NOT offer
assistance yourself or allow a stranger to use your cell phone.
• If a situation seems suspicious, look for someone to help you or dial 9-1-1.
While driving…
• Follow established roadways. Use familiar streets, not back roads or “shortcuts”.
• Make sure all doors are locked while driving.
• Put purses and/or other valuables out of sight, if possible, or cover item(s) with a towel.
• Stay alert at stop signs and traffic lights. If a stranger approaches your car at a traffic light,
drive away.
• Don’t leave your car’s engine running while you’re out of or away from the car.
• If your car breaks down or you have a flat, call for assistance from within your (locked) car
and remain inside until help arrives.
• Don’t travel to remote areas by yourself.
• Be sure you have plenty of gas before you start a trip.
• Plan your route. Get driving directions from the Internet if necessary.
If you should become involved in an accident:
• At night, drive (if possible) to a lighted area.
• If the occupants of the other car make you uncomfortable, call the police from within your
(locked) car and remain inside until the police arrive.
• Jot down the description and license number of the other car while you wait for the police.
28
29
FESA APPLICATION CHECKLIST
• Do not turn in this application until you have all components. • Electronic delivery is not appropriate – place printed copies in Dr. Stark’s faculty box in the
Copy Room, 3rd floor, Palko Building, College of Education TCU • KEEP A COPY FOR YOUR OWN RECORDS • Keep this for your records – do not turn this Checklist in with your Application
DATE COMPLETED
TASK
Complete Application for Student Affairs Practicum Form
Brief description of proposed site completed. This should be 1-3 pages, single spaced, and must include:
• Job Description – what responsibilities you will assume, obligations to the site
• Proposed Supervisor • Proposed Site Administrator • Days/Hours you are obligated to be at this site (minimum
of 10 hours per week) – give exact days and times you will be present at the site
Secure Supervisor materials and complete the “Supervisor Approval Request Form”:
• qualifications including any relevant license/certification • contact information • agreement signed and dated (must be signed and dated
for the semester you are seeking for Practicum)
Secure Site Administrator materials: • Site Administrator agreement signed and dated
Secure malpractice insurance – proof of purchase and policy
information showing your name, dates of coverage, and policy limits required
Complete TCU-COE FERPA Waiver
Complete Assumption of Risk Form (Submit the first page. Keep the second page.)
COMPLETE Application delivered to Dr. Marcella Stark
30
APPLICATION FOR STUDENT AFFAIRS PRACTICUM (EDGU 71103 Field Experience in Student Affairs) Counseling Program, TCU College of Education
If you wish to enroll in EDGU 71103, FESA, all required materials must be turned in to Dr. Marcella Stark by May 15th. The following must be submitted as a hard copy by May 15th (no electronic copies):
1. This completed application form 2. Proof that you have current malpractice insurance. This must be a photocopy of the actual policy
showing coverage limits and start/end dates of coverage. Sources from which you can secure this insurance:
a. Texas Counseling Association http://www.txca.org
b. American Counseling Association: https://www.counseling.org/membership/aca-and-you/students https://www.hpso.com/
c. American School Counselor Association: https://www.schoolcounselor.org/school-counselors-members/member-benefits-info
3. From your proposed supervisor: professional qualifications including any relevant license/certification, contact information, signed and dated agreement to meet requirements as a supervisor for your practicum (attached)
4. From your proposed site administrator: signed and dated agreement stating that the administrator approves of your assignment (attached)
5. A brief description of your proposed site, including job description, proposed supervisor, and days/hours you are obligated to at this site
6. Complete the TCU “Assumption of Risk” form and FERPA Consent to Release Educational Records and Information.
Obligations: Field Experience in Student Affairs requires the following from you:
1. Class attendance and participation 2. Minimum of 150 practicum hours 3. Other obligations as stated in the professor’s class syllabus
Name: ______________________________________________________________________ TCU Email: ____________________________ Phone: (_____)___________________ Cell phone: (_____)___________________ Mailing Address: ______________________________________________________________ Street City, State, ZIP
SUPERVISOR APPROVAL REQUEST FORM Counseling Program, College of Education
Texas Christian University Student: ___________________________________ Semester: Fall 20____ Dear Colleague: Thank you for your willingness to supervise a student for our program. In order to mentor the student who has approached you to be his/her Student Affairs Practicum Mentor, all of us – mentors, faculty, and students – need to be in agreement regarding requirements and expectations. The process has the following steps:
1. The student secures the following documents and information from you by the filing deadline: a. contact information, including email and phone numbers b. a signed and dated agreement to meet requirements as a supervisor for this practicum
student (attached) 2. Any questions you have regarding these requirements should be sent via email to Dr. Marcella
Stark ([email protected]). We commit ourselves to responding in a timely manner, knowing that your time is valuable.
3. Approval or rejection of the application is sent to the student and to the proposed supervisor by email.
All supervisors must meet the following requirements:
1. One (1) hour of one-to-one supervision per week during the semester, a minimum of 15 total hours.
2. Provide opportunities for students to interact with college/university students in a student affairs capacity.
3. Completion of evaluation forms by the semester deadlines (midterm and final). 4. Be available to the student for emergencies and other issues that may involve legal or ethical
concerns. I agree to supervise the student named above for the semester listed on this form. I have read and agree to meet the standards detailed on this form. ___________________________________ ________________________________ Signature Print Name ______________________________________________________________________ Supervisor Name and Title/Credentials
______________________________________________________________________ Site Name ______________________________________________________________________ Site Physical Address (NOT PO Box) City, State, ZIP ___________________________________ Email ___________________________________ ____________________ Daytime Phone Date
*Have you supervised TCU counseling students in the past? �Yes �No
33
SITE ADMINISTRATOR APPROVAL REQUEST FORM Counseling Program, College of Education
Texas Christian University Student: ___________________________________ Semester: Fall 20____ Dear Colleague: The student named above is seeking permission to work at your facility to meet the requirements for “Student Affairs Practicum” at TCU. By signing this document, you agree that the student has your permission to complete work that includes direct client contact at this facility to meet class requirements. Any questions you have regarding these requirements should be sent via email to Dr. Marcella Stark ([email protected]) prior to the application deadline (May 15).We commit ourselves to responding in a timely manner, knowing that your time is valuable. This student has my permission to work at the facility named below for the semester listed on this form. ___________________________________ ________________________________ Signature Print Name ___________________________________ ________________________________ Title Email ___________________________________ ________________________________ Facility Name Date
FERPA Consent to Release Educational Records and Information
This release represents your written consent to permit Texas Christian University, College of Education to disclose educational records (as noted below) and any information contained therein to the school and other agency officials with legitimate educational interests. Further, without such a release, I am unable to participate in any field-based experiences including hours of observation, clinical teaching, practicums, student teaching, or internships. This consent covers the entire student career at TCU unless revoked in writing by the student. Please read this document carefully and fill in all blanks.
I, ______________________________________________________ [print full name] am a candidate at Texas Christian University, College of Education and hereby give my voluntary consent: A. To disclose the following records:
• Records relating to any of my field-based experiences • Records relating to my performance in the field • TExES test score results in aggregate
B. To the following person(s):
• School districts or other agencies associated with field-based experiences • School-based/Agency-based administrators • School-based/Agency-based cooperating teachers/mentors • Program faculty
C. These records are being released for the purpose of:
I understand that under the Family Educational Rights and Privacy Act of 1974 (“FERPA” 20 USC 123g; 34 CFR §99; commonly known as the “Buckley Amendment”) no disclosure of my records can be made without my written consent unless otherwise provided for in legal statutes and judicial decisions. I also understand that I may revoke this consent at any time (via written request to the TCU College of Education and the TCU Registrar’s Office) except to the extent that action has already been taken upon this release. __________________________________________ ____________________________________ Signature of Candidate Date __________________________________________ ____________________________________ TCU ID Number TCU Email
TEXAS CHRISTIAN UNIVERSITY
INFORMED CONSENT AND ASSUMPTION OF RISK
IMPORTANT – READ ENTIRE AGREEMENT BEFORE SIGNING
Texas Christian University is a non-profit educational institution. References to Texas
Christian University include “TCU”, its trustees, officers, officials, employees, volunteers,
students, agents, and assigns.
I (print your name)___________________________________________________