Scientific Knowledge and Methods – “Scientific mindedness” and “scientific foundation of professional practice”: Understands and respects research and values the “marriage” between

research and practice, biological and cognitive-affective bases of behavior, and development across the lifespan.

1 2 3 4 N/O

E.7. Evidence-Based Practice – Knowledge and application of evidence-based practice in assessment, case formulation, treatment planning, intervention, consultation, supervision, outcome assessment, and other psychological procedures

1 2 3 4 N/O

Comments:

Major Professor Signature: ___________________________________ Date: ______________

Student Signature: _________________________________________ Date: ______________

Director of Training: ________________________________________ Date: ______________

APPENDIX B: Outside Experience Form Outside Experience Form

Combined Doctoral Program in Counseling Psychology and School Psychology Florida State University

Directions: Complete this form to document the nature of any paid or volunteer work involving the provision of human services that is psychological in nature and is not part of a university course, practicum, or internship. Also document the nature of any graduate assistantships or work within the university. If the faculty judge that a student’s proposed work is outside the limits of his or her training and experience, or if proposed work does not meet standards for on-site supervision, the student may not begin or continue the work and remain in the doctoral program. This form needs to be submitted to the student’s major professor before any outside work begins. This form also needs to be completed each semester even if work setting, responsibilities, and supervision do not change. The policy on outside professional work by students is contained in the Student Handbook.

Student Name: ___________________________________ Date: ___________________ Phone number: _____________________ Emergency phone number: _____________________ E-mail address: ___________________________________

Student Liability Insurance Carrier __________________________ Policy Number _________ License _____________________________ State _______ License Number_______________ Certification _________________________ Organization ______________________________ Employing Organization _________________________________________________________ Address ______________________________________________________________________ Semester ____________ Year ____________ Supervisor ______________________________________ Address_______________________________________________________________________ Phone number _____________________ Emergency phone number ______________________ Fax number _____________________

E-mail address ___________________________________

License _____________________________ State _______ License Number_______________ Certification _________________________ Organization ______________________________

Hours of individual supervision per week _____

Hours of group supervision per week (optional) ______ Major Professor: _________________________________ Work Responsibilities: 1) ___________________________________________________________________________ 2) ___________________________________________________________________________ 3) ___________________________________________________________________________ 4) ___________________________________________________________________________ 5) ___________________________________________________________________________ 6) ___________________________________________________________________________ 7) ___________________________________________________________________________ 8) ___________________________________________________________________________ 9) ___________________________________________________________________________ 10) __________________________________________________________________________ ________________________ _______________________ _______________________ Student Major Professor Dir. Clinical Training

________________________ _______________________ _______________________ Student Signature Major Prof. Signature Director Signature

Ph.D. Student Handbook APPENDIX C: Illustrative Programs of Study

School Psychology Track – Bachelor’s Admit1

FLORIDA STATE UNIVERSITY College of Education

Program of Study Doctoral Degree

Courses in italics are offered multiple semesters, and changing the sequencing of courses can be done on an individual basis, one should consult with their major professor in order to insure that all

prerequisite courses are fulfilled.

Name: Bachelor’s Admit (School Psych) FSUSN: Sample Home Phone: 850-999-9999 Business Phone: n/a

Current Mailing Address: 1205 Imaginary Lane

Current E-mail: [email protected]

Department: EPLS Major: Counseling Psychology and School Psychology

Degrees Earned

Institution: Duke University Degree: B.S. Date:

5/2008

Major: Sociology

Institution: Degree: Date: Major:

Are you Seeking FL Certification?

Yes No In what field?

Are you Certified? Yes No In what field?

Graduate Courses To Be Taken For Doctoral Degree Prefix and

No.

Descriptive Title Semester

Hours

Year and Semester Taken*

SPS 5191 Assessment of Intelligence 4 Fall 1

SPS 5055 Foundations of School Psychology 3 Fall 1

MHS 5400 Introduction to Counseling Theories and Techniques

4 Fall 1

SPS 5105 Social-Emotional Disorders of Children and Adolescents: Characteristics and Assessment

3 Fall 1

SPS 5192 Psychoeducational Assessment and Intervention

4 Spring 1

MHS 6410 Behavior Management: Principles and Applications

3 Spring 1

EDF 5481 Methods of Educational Research 3 Spring 1

MHS 6805r Practicum in Counseling and

Rehabilitation (Human Services Center)

4 Spring 1

EDF 5400 Basic Descriptive and Inferential 4 Summer 1

Statistics Applications

MHS 5511 Group Counseling: Theory and Practice 3 Summer 1

SPS 5193 Laboratory in the Assessment of Socio- Emotional Problems in Children and Adolescents

3 Summer 1

SPS 5205 Consultation in the Schools 3 Fall 2

MHS 5340 Foundations of Career Development 4 Fall 2

SPS 5945r Practicum in School Psychology 1 3-6 Fall 2

EDF 5401 General Linear Model Applications 4 Fall 2

MHS 5915r Supervised Research 2-3 (1-4) Spring 2

MHS 6946r Field Practicum in Counseling

Psychology 1 (e.g., Capital City Youth, Gadsden Women’s Prison, Turn About, ALEC)

2 Spring 2

MHS 5915r Supervised Research (Masters’ Thesis) 2-3 (1-4) Spring 2

DEP 5068 Life-Span Human Development 3 Spring 2

SPS 5945r Practicum in School Psychology 2 3 Spring 2

PSY 5605 History and Systems of Psychology 3 Summer 2

EDP 5216 Theories of Learning and Cognition in Instruction

3 Summer 2

EDF 5406 Multivariate Analysis Applications 3 Summer 2

MHS 6805r Advanced Group or Individual Counseling Practicum (Career Center Practicum)

4 Fall 3

MHS 6946r Field Practicum in Counseling

Psychology 2 (e.g., Capital City Youth, Gadsden Women’s Prison, Turn About, ALEC)

2 Fall 3

MHS 6715 Design and Critical Review of Research in Counseling

3 Fall 3

SPS 5615 Counseling Children and Adolescents 3 Fall 3

PSB 5066 Biological Bases of Learning and Behavior

3 Spring 3

MHS 5496 Current Issues in the Psychology of the Gifted (elective)

3 Spring 3

MHS 6946r Field Practicum in Counseling Psychology 3

2 Spring 3

MHS 6803 Seminar in Ethics, Law, and Clinical Supervision

3 Spring 3

MHS 8961r Preliminary Doctoral Examination 0 Spring 3

TSL 5325 English to Speakers of Other Languages (ESOL) Instruction in the Content Areas

3 Summer 3

RED 5147 OR RED 5546

Foundations of Developmental Reading OR Diagnosis of Reading Disorders

3 Summer 3

SYP 5105 Theories of Social Psychology 3 Fall 4

Ph.D. Student Handbook

of Counseling

MHS 8980r Dissertation 12 Fall 4

MHS 8980r Dissertation 12 Spring 4

MHS 8981r Dissertation Defense 0 Spring 4

SPS 6948r Internship in School Psychology 3 Spring 4

MHS 6820r Counseling Internship 3 Summer 5

MHS 6820r Counseling Internship 3 Fall 5

MHS 6820r Counseling Internship 3 Spring 5

Diagnostic Qualifying Exam (if applicable)

Spring 1

Preliminary Exam (required) Spring 3

Prospectus/Pilot Study Defense (if applicable)

Spring 3

Dissertation (minimum 24 hours) Fall 4

Dissertation Defense (must register) Spring 4

Subtotal

* Offered every other year, in odd years ** Offered every other year, in even years

Italicized Courses offered every semester

*List all courses in chronological order (past to present).

DO NOT LIST SPECIAL STUDENT/TRANSFER WORK ON THIS PAGE.