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Application Checklist

The Field Experience Application is designed as a checklist of items that must be completed for approval. The checklist contains some or all of the following items, depending on your program and the details of your field experience:

Documents to Upload to Meditrek

The items in this part of the Application Checklist are documents that you need to upload to Meditrek.

  • PhD-CES Individual Internship Plan Form (CES Internship ONLY)
  • Doctoral Internship Supplements (CES Internship ONLY)
  • Field Experience Application Worksheet
  • Student Professional Liability Insurance Certificate
  • Counseling Work Sample Case Note (will be added to checklist if Counseling Work Sample is required)
  • Counseling Work Sample Informed Consent (will be added to checklist if Counseling Work Sample is required)

Forms to Complete in Meditrek

This section is comprised of forms that must be completed directly in Meditrek. Many forms have both a “Submit” and a “Save Draft” option at the bottom of the screen. You can select “Save Draft” to save the information that you have entered and come back to complete the form later. If you’ve clicked “Submit” and there are any incomplete items, the page will refresh with red asterisks indicating which sections still need to be completed.

  • Student Information
  • FERPA Release
  • State Education Specialization
  • Required Field Experience Training
  • Field Experience Application Acknowledgements
  • Demonstration of Skills Competency
  • Student Eligibility Audit
  • State Education Specialization
  • Field Site Information
  • Site Supervisor Information
  • In-Home Counseling
  • Telemental Health
  • COVID-19 Acknowledgement