APA Accredited Internship in Clinical and Counseling Psychology

Intern Training Report

Date:

Intern:

Primary Supervisor:

Outreach Programs:

Supervision Assignment:

On call rotation:

Committees:

Number of hours of supervision received:

Number of Intakes:

Individual Clients:

·        Number of clients:

·        Client hours total:

·        Client diversity (gender, race, sexual orientation, age, disability):

·        Client diversity (diagnostic types):

Couples (number):

Groups:

Assessment:

·        Instruments used and number:

·        Number full batteries:

Continuing Education (received outside CCC):

Professional Organization membership/leadership:

Volunteer Activities:

Research:

Publications: