EmailMe Form - Counseling Work Sample Submission Form

Counseling Work Sample Submission Form

After uploading your mock session to OneDrive, please complete the information below and upload the DAP/SOAP note and Informed Consent Form where indicated to submit your Counseling Work Sample for review.

For step-by-step instructions for completing your work sample, including how to upload your video, see the Counseling Work Sample Instructions document available at the following link: https://academicguides.waldenu.edu/fieldexperience/soc/masters/programresources/evaluation/cws

Name *
First Last
Student ID *
Quarter to Begin Field Experience
Video Link 1: *
Video Link 2 (if applicable):
Informed Consent Form *

Add File
Case Note *

Add File
Notes:
Mock Session *
I certify that the video I have uploaded is a mock session with a mock client and the scenario is fictitious.
I certify that the mock session was not scripted or previously rehearsed prior to filming.
I certify that this is new work sample recorded for the purpose of the Counseling Work Sample for field experience. It has not been submitted previously for any purpose.