FGCU College of Education | Mental Health Counseling

Clinical experiences are only offered during the fall and spring semesters. The following application must be submitted by October 15th for the spring semester and by March 15th for the fall semester.

First Name
Last Name
Semester Term	Fall Spring Summer
Semester Year
Social Security #
Street Address
City
State
Zip
Work Phone
Home Phone
Email
Track	Mental Health School
Proposed Clinical Site
Proposed Site Supervisor Prefix
Proposed Site Supervisor First Name
Proposed Site Supervisor Last Name
Proposed Site Phone
Proposed Site Street Address
Proposed Site City
Proposed Site State
Proposed Site Zip
Liability Insurance	Liability insurance is required for all clinical experiences. Student Insurance is available from ACA or ASCA at very reasonable rates, and applications are available online.
	I have liability insurance I do not yet have liability insurance but will provide verification of coverage prior to the beginning of the semester.

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