Clinical Experience Survey
This form should be completed at the end of the clinical experience. The below questions are focused on your ENTIRE clinical experience.
Student's Name
*
First Name
Last Name
Student's Email
*
Date submitted
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Date Submitted
*
-
Month
-
Day
Year
Date
How long did it take you to locate, contract, and receive final approval for your site and/or supervisor?
Less than 6 weeks
6-12 weeks
12-18 weeks
18-24 weeks
More than 24 weeks
How many University faculty supervisors did you have throughout your clinical experience?
How many Local Clinical Supervisors did you have throughout your clinical experience?
Was your Local Clinical Supervisor(s) AAMFT Approved?
Yes
No
Had multiple; at least one was
How many sites did you have throughout your clinical experience?
Did you engage in telesupervision with your LOCAL supervisor at any time?
Yes
No
Did you engage in teletherapy at any time?
Yes
No
Which University Clinical Courses did you take?
Practicum I
Practicum II
Internship I
Internship II
Capstone
Internship III
Internship IV
Internship V
Internship VI
Other
Please indicate if you took advantage of any of the below resources:
YES
NO
UNSURE
CPP Q & A
One-on-One meeting with a member of the Clinical Administrative Team
Tips Sheets in MFT Clinical Support module (NCU One)
Reach out or Resume template in MFT Clinical Support module (NCU One)
Theoretical Resources in MFT Clinical Support module (NCU One)
Course Resources in MFT Clinical Support module (NCU One)
Clinical Development Committee (CDC) meeting
List 2-3 parts of the clinical experience that you found most helpful to your development as a MFT. What helped you grow?
List any issues that seemed to be barriers to your development during the clinical experience. What were challenges you faced?
What are your reflections of telesupervision with your LOCAL supervisor (pros, cons, benefits, challenges)?
What are your reflections of teletherapy (pros, cons, benefits, challenges)?
Please indicate your perceived level of competence in the following areas:
Not Competent
Somewhat Competent
Competent
Very Competent
Working with diverse populations in clinical settings.
Applying family systems oriented clinical skills across a variety of contexts.
Contrasting family systems theory oriented models of therapy.
Formulating a decision-making process for ethical dilemmas congruent with the AAMFT Code of Ethics.
Using the supervision process for the development of MFT clinical competence.
Please consider these two questions. What advice would you give to students who haven't started their clinical experience yet? What advice would you give to students on Day 1 of their clinical experience?
Do you plan on continuing your work with your supervisor post-graduation?
YES
NO
UNSURE
What are your plans for employment post-graduation?
Stay with site as hired post-graduate
Pursuing clinical position at different site
Pursuing non-clinical position
Do you plan on pursuing another degree (e.g., PhD, Masters, Certificate)?
YES
NO
UNSURE
Related to licensure (check all that apply):
I have applied for limited or full licensure
I am scheduled to take the exam(s)
I have taken the licensing exam(s)
I passed the exam
What state(s) do you plan on getting licensed in? If none, type N/A.
Do you plan to become an AAMFT supervisor in your state?
YES
NO
UNSURE
Please share any additional feedback or comments here:
Submit
Should be Empty: