Current Students
Contact the Department
Dominican University of California, Department of Counseling Psychology,
50 Acacia Avenue, San Rafael, CA 94901-2298 - (415) 485-3263
Program Manager: Ginia Laudisio at: laudisio@dominican.edu
Awards
Dr. Robert Shukraft Award - Annual award presented to a student in the Department of Counseling Psychology at the Student Forum meeting in May. This award was instituted in memory of Bob Shukraft, a beloved and inspirational instructor and mentor in our program for fourteen years, 1978-1992. He was well known for bringing out the best in his students, encouraging them to express their own individual style and to follow their dreams. Remember to nominate and vote for your fellow students. Details for how to participate to be announced in Spring.
Psi Chi Award - Annual service award presented to a student member of Psi Chi, the national honor society in psychology, for outstanding service to the Department of Counseling Psychology.
Outstanding Student Award - Annual award presented to a student chosen by Department of Counseling Psychology faculty in recognition of a student's outstanding performance in academic and clinical work.
General Forms
| Outline of Possible Course Sequence | Possible outline to complete a three year Counseling Psychology Course sequence, as suggested by Dominican students. | |
| Application for Candidacy | Designed for mid-level students to advance to candidacy status. To be filed after completion of 24 units, nine of which must be in CP 5200, 5203, 5204, 5205, 5207, 4208 and at least 3 units in CP 5294. Check with Counseling Psychology Department office for form deadlines. | |
| Verification of Psychotherapy | Complete this form to verify the 45 hours of personal, individual, couple or family psychotherapy as required by the Department of Counseling Psychology. | |
| Approved Equivalent Courses at Other Institutions | List of courses offered at other Bay Area schools which serve as equivalent courses for Dominican requirements. (See also: Preliminary Course Equivalency, Certificate of Course Equivalency and Transfer of Units) | |
| CCPR Information | Information sheet detailing the purpose, format, and procedures involved in completing the CCPR. | |
| CCPR Application | Registration application to take the CCPR. | |
| CCPR Reviewer Rating Scale | Scoring sheet for reviewing student CCPR's. | |
| Permission to Take MFT Specialization Courses Without Candidacy Status | To be completed prior to registration. | |
| Preliminary Course Equivalency | Permission to take a Dominican course equivalency. | |
| Transfer of Units | Must be competed in order to transfer credits from approved equivalency courses at other institution to Dominican. | |
| Certification of Course Equivalency | Additional form to complete for approval of approved equivalency courses at other institutions. | |
| Student Recommendation for Psychotherapist | To recommend a therapist to other Dominican Students. | |
| Fieldwork Forms | ||
| Dominican Forms | ||
| How to Evaluate Fieldwork Placements | ||
| Fieldwork Placement Forms - Instructions | Instructions on how to use the various fieldwork forms, copies required and where to send them. (Note: always keep copies of all forms for your own records) | |
| Required Hours for MFT Certification | Breakdown of the 3,000 required by the BBS for licensure | |
| Graduate Fieldwork Application for Trainees | Must be filled out and turned into the Department of Counseling Psychology by appropriate deadlines. Copies (3): Original to CP Office, copy for your records, copy to on-site supervisor. | |
| Verification of Fieldwork Continuance | Must be used if the student has the SAME fieldwork supervisor as in the previous semester(s). If the agency is the same, but the supervisor is different, a new Graduate Fieldwork Application must be competed. | |
| On-Site Supervisor's Fieldwork Evaluation | Must be filled out by the on-site supervisor at the end of each semester of fieldwork. This form is sent out each semester the Department office to the supervisor. | |
| File Checklist Fieldwork Experience | Tracking form to keep record of your cumulative hours over a four-semester period | |
| BBS Forms | Most of these forms are "pdf enhanced" so they can be filled out online. Select the "hand" tool from the Acrobat Reader tool bar. | Move it to the first blank field or line and the hand will change to a cursor. Type your entry, then tab to the next space and type your information. |
| Marriage and Family Therapist Experience Verification | Upon completion of supervised experience at each fieldwork placement, the supervisor completes this form. After completion, this form must be submitted with the application to take the MFT licensure exams. | |
| Weekly Summary of Hours of Experience | This log form must be filled out weekly by students and get signed off weekly by the on-site supervisor. It may be required by the BBS. | |
| Responsibility Statement for Supervisors of a Marriage, Family, and Child Counselor, Intern or Trainee | Must be signed by the on-site supervisor from each fieldwork placement prior to the commencement of any supervision. After graduation from the Master's Program, this form (forms) must be submitted to the BBS with the application to take the MFT licensure exams. | |
| Marriage and Family Therapist Intern Registration Application Packet | Application packet to become a registered MFT intern, completed after obtaining your degree. | |
| Marriage and Family Therapist Application Packet | Application packet to complete to receive your MFT license. (Please note that you are no longer required to fill out a separate form documenting personal psychotherapy. Question #17 on this form is now where you may document up to 100 hours of personal individual or group psychotherapy which may be "triple counted" for up to 300 total hours.) |
Important: You must hit either the tab key or the enter key after typing in each blank on the form, or your entry won't be accepted and the information you typed won't print. To use check boxes, move the hand tool over the box and when hand becomes an arrow or finger, click once to mark box. Clicking again will remove mark.
