MAMFT Clinical Hours Summary

Date*

Date

Student*

First NameLast Name

Student E-mail*

State Seeking Licensure In*

Select your current clinical course name*

Select your Specialization*

Select Current University Group Faculty*

Liability Expiration Date*

Date

Indicate your site(s), supervisor(s), and status for each. Please note that you need to communicate ANY changes in your site to the clinical admin team at MFTtraining@nu.edu:

	Name of Site	Supervisor for Site	Status of Site
Site One
Site Two
Site Three
Site Four
Site Five

Based on the licensing state you selected, you will need more therapy hours than the minimum program requirements. See the information below related to specific state requirements.

500 direct client contact hours: Alabama, Alaska, Arkansas, Kansas, Mississippi, Montana, Rhode Island, and Wyoming
450 direct client contact hours: Virginia
250 relational hours: Alabama, Montana, North Dakota, and Rhode Island
200 relational hours: Arkansas, Mississippi, Virginia, and Wyoming

If you need additional information about licensure requirements, please contact the licensure division of your state.

{student}, for these hour tables ONLY enter in numbers in the first open column that is titled "Student: List APPROVED Hours ONLY." Do NOT add any hours to the Faculty or Admin columns.

MAMFT THERAPY Hours APPROVED in Clinical Tracking System

	Student: List APPROVED Hours ONLY	Faculty: Any Adjusted Hours	Admin: Any Adjusted Hours
TOTAL DIRECT THERAPY (Individual + Relational) - 300 minimum required
RELATIONAL - 150 minimum required
IN-PERSON - 50 minimum required
CO-THERAPY - 50 maximum allowed
SPECIALIZATION - 50 minimum required (if applicable)

Do you have less than 142 total approved direct therapy hours OR less than 72 approved relational therapy hours?

YESNO

Do you have less than 200 total approved direct therapy hours OR less than 110 approved relational therapy hours?

YESNO

Based on the hours you have reported, you are at risk of not completing your clinical training hours requirement without adding at least one clinical extension course. The program strongly recommends that you discuss the possibility of adding additional sites with your assigned University Clinical Supervisor.

Please acknowledge the following the statements:

I am aware my hours are below the expected direct client contact and/or relational hours identified by the program.I understand the program strongly recommends that I speak with my University Clinical Supervisor about the potential need to add an additional site to complete my clinical requirements.I understand that I may need to take additional clinical extension courses if I do not meet the minimum clinical hours requirements to enter my capstone course.

MAMFT SUPERVISION Hours APPROVED in Clinical Tracking System

	Student: List APPROVED Hours ONLY	Faculty: Any Adjusted Hours	Admin: Any Adjusted Hours
TOTAL UNIVERSITY SUPERVISION - 100 minimum required
*University Observable Data - 50 minimum required
TOTAL LOCAL SUPERVISION - 100 required for CA students only
LOCAL INDIVIDUAL SUPERVISION - 52 minimum required
IN-PERSON SUPERVISION- 12 minimum required
*Local Observable Data - no minimum

Please upload the #523 Report - Approved Hours Log and the #514 Report (for co-therapy and specialization hour tracking) from Tevera.

Browse Files

If students do not have the minimum hours needed or they are not clinically ready, an extension course will be scheduled prior to the 4-week long Capstone course. The extension courses are either 4, 8, or 12 weeks in length.

The length of the extension course needed is determined in the following way:

MFT 6935: 4-week extension course is appropriate if ANY of the following are true
- there are minor adjustments to the Capstone draft needed
- 15-35 therapy hours still needed until therapy graduation requirements are met
- 4-8 individual supervision hours until therapy graduation requirements are met
- do not have at least 96 university group supervision hours
MFT 6936: 8-week extension course is appropriate if ANY of the following are true
- there are significant adjustments to the Capstone draft needed
- 36-70 therapy hours still needed until therapy graduation requirements are met
- 8-12 individual supervision hours until therapy graduation requirements are met
MFT 6937: 12-week extension course is appropriate if ANY of the following are true
- there are significant adjustments to the Capstone draft needed
- 71+ therapy hours still needed until therapy graduation requirements are met
- 12+ individual supervision hours until therapy graduation requirements are met

Students need at least 100 total University Group Supervision hours to meet graduation requirements. If students do not have at least 96 university group supervision hours (see hours chart in week 10 of Internship II) this will result in an extension course before capstone depending on hours needed to meet this requirement.

Students need at least 50 observable data hours from University Group Supervision to meet graduation requirements, per COAMFTE (see MAMFT hours accrual expectations chart in MFT Clinical Support Module in learning platform).

- Faculty, please be sure to also comment in their section on student's clinical readiness based on the Capstone draft.

FOR STUDENTS IN INTERNSHIP II OR AN EXTENSION COURSE: Based on the above explanation, which course are you eligible for based on your APPROVED hours in Tevera

MFT 6934 CapstoneMFT 6935 the 4-week extensionMFT 6936 the 8-week extensionMFT 6937 the 12-week extension

During the past 10 weeks that you have been enrolled in this course, have you worked with at least one client who fits the COAMFTE Definition of Diverse, Marginalized, and/or Underserved Communities?*

YesNo

Did you earn client or supervision hours prior to your NU clinical experience that NU accepted?

YesNo

Please share any information you'd like the clinical team to know about your current hours accrual:

I acknowledge that I, the student, understand that if I proceed into the capstone course, but do not meet the hours requirements for graduation before capstone ends, I will need to enroll in an extension course until all clinical training requirements are complete.*

Yes, I acknowledge and understand the statement above

{student}, Your faculty will complete their section of this form. Upon completion you will receive an email.

For Faculty Use Only

Are reported clinical hours accurate?

YesNo

Which sequence is this student in?

6951 - 69926930 - 6933

Based on the students hours and Capstone draft, which course should the student enter next?

MFT 6934 CapstoneMFT 6935 the 4-week extensionMFT 6936 the 8-week extensionMFT 6937 the 12-week extension

Do students have the APPROVED hours to enter into Capstone?

YesNo

Are students clinically ready to enter into Capstone?

YesNo

Please provide additional information and/or recommendations pertaining to the student's clinical readiness. Specifically, we would like you to comment on clinical skills and progress as seen from case presentations:

Faculty Signature

Date

For Administrator Use Only

Course Enrollment Plan

Clinical Team Comments

Start Date of Clinical Experience

Date

Final Date of Clinical Experience

Date