University of Manitoba Clinical Psychology Practicum Contract Practicum Details: Practicum Start Date Academic Term: Term Year (MM/DD/YYYY): Fall Fall/Winter Winter Summer Student Name: Student email: Practicum Course Name/Number (circle): CASE Conceptualization Clinical PSC Practicum I - PSYC 7910 PSC Practicum II - PSYC 7920 PSC Practicum III - PSYC 7930 Senior Practicum - PSYC 7940 Senior Practicum - PSYC 7950 Senior Practicum - PSYC 7952 Optional Senior Practicum - PSYC 7954 Optional Senior Practicum - PSYC 7956 OTHER If OTHER selected, list Course Name/Number: Note: Students are only eligible to take PSYC 7930 (3rd practicum) if their Master's Defense date is scheduled and they have approval from their Research Advisor. Practicum Type (circle): PSC In-House General Practicum PSC In-House Specialty Senior Practicum PSC Case Conceptualization Clinical Component PSC Supervision Course Clinical Component External Specialty Practicum WRHA-CHP External Specialty Practicum Practicum Location: Practicum Supervisors: Primary Supervisor: Email: Secondary Supervisor Email: (if applicable): Secondary Supervisor Email: (if applicable): Time Involved/ Caseload: Client Population & Clinical Setting:
University of Manitoba Clinical Psychology Practicum Contract Term Year Fall Fall/Winter Winter Summer Practicum Details: Practicum Start Date (MM/DD/YYYY): Academic Term: Student Name: Student email: CASE Conceptualization Clinical PSC Practicum I - PSYC 7910 PSC Practicum II - PSYC 7920 PSC Practicum III - PSYC 7930 Senior Practicum - PSYC 7940 Senior Practicum - PSYC 7950 Senior Practicum - PSYC 7952 Optional Senior Practicum - PSYC 7954 Optional Senior Practicum - PSYC 7956 OTHER Practicum Course Name/Number (circle): If OTHER selected, list Course Name/Number: Note: Students are only eligible to take PSYC 7930 (3rd practicum) if their Master's Defense date is scheduled and they have approval from their Research Advisor. Practicum Type (circle): PSC In-House General Practicum PSC In-House Specialty Senior Practicum PSC Case Conceptualization Clinical Component PSC Supervision Course Clinical Component External Specialty Practicum WRHA-CHP External Specialty Practicum Practicum Location: Practicum Supervisors: Primary Supervisor: Email: Secondary Supervisor (if applicable): Email: Secondary Supervisor (if applicable): Email: Time Involved/ Caseload: Client Population & Clinical Setting:
Clinical_Psychology_Practicum_Contract_Plain_Word_Version-November_2018.docx