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Form 2INT - Certification of Supervised Internship and Practicum

This form must be submitted directly by the educational institution where your supervised internship and practicum in Mental Health Counseling was part of your graduate program. Please note that this form is NOT REQUIRED for graduates of 60 credit hour CACREP accredited clinical mental health counseling or NYS registered licensure qualifying MHC programs. The Office of the Professions will not accept this form if submitted by the applicant. Note: Syllabi cannot be accepted in lieu of completion of this form.

  • Section I: Complete this section before sending the entire form to where your supervised internship and practicum in Mental Health Counseling was part of your graduate program. Be sure to sign and date item 9 and include any fee required by the institution.
  • Section II: The Director must complete this section and return all pages of the form along with any other required documentation in an official envelope directly to the Office of the Professions at the address at the end of the form.