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Counseling Work Sample Submission Form
After uploading your mock session to OneDrive, please complete the information below and upload the DAP note, transcript and Informed Consent/Client Feedback 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
Please select
Winter 2016/2017
Spring 2017
Summer 2017
Fall 2017
Winter 2017/2018
Spring 2018
Summer 2018
Fall 2018
Winter 2018/2019
Spring 2019
Summer 2019
Fall 2019
Winter 2019/2020
Spring 2020
Summer 2020
Fall 2020
Winter 2020/2021
Video Link 1:
*
Video Link 2 (if applicable):
Informed Consent/Client Feedback Form
*
Add File
Case Note
*
Add File
Notes:
Mock Session
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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.
