Resources for Success

Fieldwork Forms

This section will give a brief description and explanation of the forms you’ll need to keep records of throughout your traineeship, which are available for download here as well. There is a lot of paperwork that goes with this process. Take the time to learn what each is for and keep an organized record to avoid any confusion and unnecessary anxiety. The forms will be listed in the order they were mentioned in the timeline in order to minimize confusion. This is most likely the order that you’ll be using them in once you get started on the process.
CSUN Forms
Student Release Form (Form 5):
The Student Release Form is simply what it states. It is the form that the trainee signs upon beginning a traineeship that releases CSUN from any and all claims against the University in regards to your traineeship. It’s a formality, and it must be signed and given to your practicum instructor so that you can begin your fieldwork.

Field Placement Agreement (Form 6):
The Field Placement Contract is a formal agreement that describes the responsibilities of the student, site, and university and details the unique features of a particular student's placement (e.g., hours, supervisor). The agreement should be filled out jointly by the student and the supervisor so that both parties are aware of their own and the other’s responsibilities. The form must be signed by the fieldwork instructor prior to seeing clients; hours accrued before supervisor has signed the contract do not count towards graduation.

Field Placement Information for Online Evaluation (Form 6A):
This form is to be filled out by you, and by your primary supervisor at your field site. It asks for basic information so that an online evaluation can be sent to your supervisor’s email address and sent back to the University. Your supervisor must fill out an online evaluation of you every semester, so if your supervisor changes, if you change field sites, or if you’re working at more than one field site, fill these forms out accordingly. If a supervisor refuses to do an online evaluation, he/she may not supervise you; a new supervisor will need to be organized.

CSUN Weekly Summary of Hours:
This is the form that you will use to record all of the hours that you accrue at your field site as well as at the University. The top half of the form should be signed weekly by your supervisor. The bottom half of the form is to record additional hours for CSUN. In this part of the form you will record your fieldwork class hours (practicum) and use of professional resources. The bottom half of your form should be signed weekly by your Practicum instructor. You will use as many of these forms as necessary to keep track of all of your hours earned. The original of the logs should be given to your practicum instructor each semester. Keep your copies in a safe place! Here is a
completed sample form, and an excel version of the form. Also, we have outlined guidelines and definitions here.

MFT Program Requirement Approval (Form 10):
This form is a summary of the requirements that each students needs to fulfill throughout their graduate degree program in order to be approved for graduation. On it you will record dates of the workshops you’ve attended (including the mandatory child abuse and domestic violence workshops, along with 2 others of your choice), personal counseling verification, mentoring, fieldwork forms and hours of experience. This form will be completed by your EPC 690 instructor or 659Q instructor.

Instructions for Video Camera Usage:
This sheet explains how to use the cameras distributed in your Practicum class to record live sessions.

Video Recording Form:
This is a consent form to be given to, explained and completed by your clients as consent to record your session.

BBS Forms
You can also download these forms directly from the BBS Website (we recommend checking often for updates):

BBS Supervisor Agreement Form:
This form is for the BBS and needs to be filled out prior to beginning your fieldwork placement. The form is to be filled out by your supervisor at your fieldsite and handed in to your practicum instructor at your second class meeting.

BBS Weekly Summary of Hours Experience:
This is the form that you will use to record all of the hours that you accrue at your fieldsite. This will include, direct client contact hours, supervision hours, training hours, progress note hours etc. This form should be signed weekly by your onsite supervisor, and is necessary for licensure, so make sure to keep impeccable records. This form does not need to be turned into your practicum instructor, but must be kept for your records for licensure.

BBS Experience Verification Form:
The experience verification form is a BBS form that records your accumulated hours for each placement that you have had. You must have one Experience Verification Form for each placement that you have worked at and it must be signed by your primary supervisor at your site. These forms are not needed for graduation, but they are needed for licensure as a Marriage and Family Therapist. The reason the form is mentioned here is that if you are only at a site for a certain amount of time and move to a different site, you’ll want to make sure your primary supervisor at that site fills this form out and signs it so that you don’t have to go on a wild goose hunt years later when applying for licensure.