UW-Madison - Department of Counseling Psychology - PhD Forms and Resources

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CONTACTING US

Main Office

Department of
Counseling Psychology

School of Education
UW-Madison
335 Education Building
1000 Bascom Mall
MadisonWI  53706-1326

Tel: 608/262-4807
Fax: 608/265-3347

Email: counpsych@education.wisc.edu
or by contact form
 

Ph.D. Program Forms and Professional Resources

Program Forms

For students who wish to petition for a program variance, please initiate the petition with their advisors. A written petition secures a place on the closed portion of the next faculty meeting. The results of the faculty action are recorded in the faculty meeting minutes. A copy of the minutes is also placed in the student's file.

Coursework

  • Student Program Worksheet pdf | Word

Evaluation of Practicum Readiness

  • Evaluation of Ph.D. Student by Department Faculty for Practicum Readiness pdf | Word

Verification Forms

  • Handbook Verification Form pdf | Word
  • Ethics Verification Form pdf | Word

Doctoral Student Report on Progress

  • Doctoral Student Report on Progress pdf | Word
  • File Audit Form pdf | Word
  • Individual Development Plan pdf | Word

Practicum Forms: Foundational and Advanced

  • Evaluation of Practicum Student by Supervisor pdf | Word
  • Student Evaluation of Supervision pdf | Word 
  • Statement of Clinical Accountability Form pdf | Word
  • Statement of Monthly Clinical and Supervision Hours pdf | Word

Preliminary Examination

  • Evaluation of Preliminary Examination Part 1: Clinical Case pdf | Word
  • Evaluation of Preliminary Examination Part 2: Supervision Case pdf | Word
  • Dissertation Proposal Request Form pdf | Word (submit 4 weeks prior to the Dissertation Proposal)
  • Evaluation of Preliminary Examination Part 3: Dissertation Proposal pdf | Word
  • Preliminary Examination Dates

Advancement to Dissertator Status

  • Ph.D. Minor Agreement Form pdf | Word
  • Request for Advancement to Dissertator Status pdf | Word

Externship

  • Externship Application Plan pdf | Word
  • Statement of Clinical Accountability Form pdf | Word
  • Evaluation of Externship Student by Supervisor pdf | Word

Internship

  • Internship Application Plan pdfWord
  • Internal Verification of Internship Readiness pdf | Word

Program Administration

  • Program Approval Form - Advisor Approved Actions pdf | Word
  • Program Approval Form - Faculty Approved Actions pdf | Word
  • Change of Advisor Form pdf | Word
  • Secondary Practicum Agreement Form and Site Information  pdf | Word
  • Department Sanctioned Non-practicum Clinical Experience Application Plan pdf | Word
  • Grievance Procedure​  

Remediation Plan: Development Guidelines

  • Remediation Plan Development Guidelines pdf | Word

Institutional Review Board (IRB) Forms

All students in the department conducting research is required to complete an on-line tutorial program and and complete an IRB protocol prior to beginning research.

Criminal Background Forms




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