UW-Madison - Department of Counseling Psychology - Master's Forms

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Main Office

Department of
Counseling Psychology

School of Education
335 Education Building
1000 Bascom Mall
MadisonWI  53706-1326

Tel: 608/262-4807
Fax: 608/265-4174

Email: counpsych@education.wisc.edu
or by contact form

Master's Program Forms

Practicum and Internship Forms

  • ​Master's Internship Application Form PDFWord
  • CP 806 MS Practicum Evaluation by Supervisor form PDF | Word
  • Statement of Clinical Accountability Form ​PDF | Word
  • Evaluation of Student by Supervisor PDF | Word
  • Student Evaluation of Supervis​ion PDF | Word
  • Evaluation of Practicum Site PDF | Word
  • Practicum Experience Application Plan PDF | Word

Secondary Sites

  • Secondary Practicum Agreement Form PDFWord
  • Secondary Practicum Site Information Form PDF | Word

Program Forms and Information

Students who wish to petition for a program variance, initiate the petition with their advisors. A written petition secures a place on the closed portion of the next faculty meeting. The results of the faculty action are recorded in the faculty meeting minutes. A copy of the minutes is also placed in the student's file.



  •  Professional Integration Exercise (PIE)​ Evaluation Form PDF | Word

Criminal Background Forms

  • Criminal Background Check Information PDF
  • Disclosure Authorization and Waiver Form PDF
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