SECTION II: PROGRAM POLICIES

Student Review and Retention Policy

Successful completion of a graduate program in counseling is based on the demonstration of effectiveness in academic, professional, and personal areas as they relate to the counseling profession. The faculty of the Department of Counselor Education have a professional responsibility to evaluate the academic, professional, and personal development of students in training programs. Evaluation procedures serve two major purposes:

1. To provide students with information related to their progress that will enable them to take advantage of strengths and to remediate weaknesses in their academic, professional, and personal development.
2. To provide faculty with information about student progress which will facilitate decisions that are in the best interests of students and the profession they are preparing to enter.

The Student Review and Retention policy for the Master of Arts in Counseling describes the process for faculty sharing of information about student progress. For courses with Key Performance Indicators (KPIs), students must earn a “2” or higher on each domain of the KPI rubric. If they earn less than a “2,” they will work with the instructor to remediate the assignment. Faculty review student dispositions formally once a year using the PPAAD assessment. Students who earn a “1” on any item must meet with their advisor to discuss concerns and develop a remediation plan. Student review is also ongoing and continuous. The faculty is concerned about the suitability of a student entering a profession with evidence of unsatisfactory performance in practical skills, behaviors which are unethical, illegal, or unprofessional, and/or dispositions deemed inappropriate for a professional counselor. Any faculty member may raise questions about a particular student’s performance and progress at any time. Discussions of student performance and progress will be held in “executive session.” Note that all students are reviewed by all program faculty several times a year.

If, in the professional judgment of the program faculty, a student’s behavior is deemed substandard, unethical, illegal, and/or professionally unbecoming during the course of training (including course work, practicum, externships, and internships), the following steps are taken:

11. Within ten (10) academic days, the cohort advisor will inform the student in writing of the identified problem areas noted by the faculty, requesting an appointment to provide the student with feedback and appropriate and/or remedial procedures expected of the student in order to return to good standing with the program.
12. During the appointment with the cohort advisor, the advisor will discuss with the student a written plan for remediation of the student’s behavior which:
    1. Behaviorally defines the student’s problems
    2. Identifies the expected behavior patterns or goals
    3. Specifies possible methods to reach the goals, which could include:
       1. Personal counseling
       2. Group growth experiences
       3. Self-structured behavioral change
       4. Additional academic course work or practicum, field experience, etc.
       5. Specifies possible resources available to assist the student in achieving satisfactory performance and/or behavior change
       6. Designates a way in which the goal attainments will be demonstrated
       7. Sets a date for re-evaluation and/or goal attainment
13. A copy of the approved plan will be provided to the student and a copy will be retained in the student’s file in the Department of Counselor Education. Both copies of the plan will be signed and dated.
14. At or near the date set for re-evaluation, the student’s progress will be reviewed by the faculty, with four options of recommendation:
    1. Continuation in the program: the specified concerns no longer present a significant problem and the student is allowed to continue in the program.
    2. Probation and remediation: progress is documented on the first evaluation, an updated behavioral plan is prepared, and a date is set for another re-evaluation.
    3. Voluntary resignation: progress is documented as insufficient with the recommendation that the student resign from the program.
    4. Dismissal from the program: the student has failed to attain the behavioral goals and there is no expectation that he or she can reasonably attain them in the near future.
15. The student will be immediately notified in writing by the cohort advisor of the re-evaluation decision, requesting the student make an appointment with the advisor, and specifying if the student is on conduct or professional probation within the Program. If dismissal from the program is recommended by the faculty, the notice will include the specific reasons for the potential termination.
    Note: Academic Probation is governed by Graduate College Regulations.
16. Depending upon the re-evaluation decision (as outlined in sections 4-1, 4-2, 4-3, and 4-4) by the faculty, the student and the cohort advisor will review the options available to the student.
17. If 4-4 Dismissal from the program is the decision, the student will be given thirty (30) days from the meeting with the cohort advisor in which to, if the student choses. 
    1.  and present to the program faculty a written response to the decision and
    2. Request, in writing, a full counseling faculty review of the decision.
18. Upon receipt of a written request from the student, a faculty meeting will be held within twenty (20) academic days to provide the student with the opportunity to present his or her case to the faculty.
19. Following the student’s presentation, the program faculty will meet to:
    11. Review the student’s progress in the program
    12. Review the student’s behaviors as related to expected professional and/or personal dispositions and behavior
    13. Review the student’s remediation progress
    14. Render a decision as to whether the dismissal recommendation is upheld.
20. Immediate notification of the decision will be provided to the student by the chair of the Counselor Education Department with a copy to the Dean of the Graduate College and the Dean of the College of Education.
21. If the dismissal decision is upheld, the chair of the Counselor Education Department will submit a formal recommendation for an administrative withdrawal.
22. If a student’s unacceptable professional and/or personal behaviors are deemed severe enough by the program faculty, a recommendation for immediate dismissal from the program will be made. Steps 1 through 8 of this policy will not be employed in this circumstance. The student will be informed of the recommendation by letter from the Chair of the Counselor Education Department, with copies to the Dean of the College of Education and the Dean of the Graduate College. Steps 9-13 will then be implemented.
23. If the student is not satisfied with the decision reached by program faculty, the appeals procedure is outlined in the Student Code of Conduct (Policy 2020), See: boisestate.edu/policy/student-affairs/code-of-conduct.

Classroom Technology Policy

Technology can be a valuable tool for learning and connection.  Technology use in the classroom, however, is often distracting and can be a deterrent to engaged learning.  An emerging body of literature provides mounting evidence for decreased learning outcomes when students use technology during class (e.g., notetaking, web-surfing, etc.).  Further, as counselors-in-training, you need to develop the capacity to be fully present, attuned, and curious.  Not using computers, tablets, and cellphones in classrooms allows for the opportunity to develop such capacities.

For our part, as instructors, we will strive to create learning experiences that are meaningful and relevant so that the temptation to disengage through technology is minimal.  We will frequently integrate experiential learning exercises, small group discussions, and other such teaching strategies into lectures in order to enhance attention and promote deeper learning.  However, there will be times that we will teach through traditional lectures and/or other didactic approaches.  These are perfect opportunities for you to practice attentive listening skills!

Given the above rationale, we ask that students refrain from using laptops, tablets, and cellphones in class, except when explicitly requested by the instructor (e.g., for use on a project, learning exercise, etc.).

If you believe you need an exemption from this policy, please speak to the course instructor before the start of the course.

Netiquette Policy

Netiquette refers to the proper way to engage in online communication.  Online communication happens in a variety of ways throughout your training to become a professional counselor.  For example, you will be emailing your professors and classmates frequently, you will engage in online discussion forums for classes, and you will be communicating through electronic means during your practicum and internship experiences.  We expect that all students communicate professionally at all times.  Here are some basic guidelines for electronic communication:

1. When emailing, use your “u.boisestate.edu” email account provided by the university.  If you have your email forwarded to your smartphone or another email service, remember to select that outgoing mail be sent through your Boise State address.
2. Use professional greetings in your emails.  An appropriate greeting to the professor of your course is “Hello Dr. Smith,” not “Hey there/What’s up” or no greeting at all.
3. Use a professional and respectful tone in your email, this is good practice for the communication you will engage in with future employers.
4. Remember to sign your name upon completion of your email.  If using a smartphone or tablet, it may be helpful to turn on your automatic signature with a professional closing which identifies you.
5. Include the course number or reason for your email in the signature line.  If you are emailing about a question from your Counseling Theories course, include “COUN 502” in the subject line.  Faculty members receive many emails daily; this identification can help ensure your email is read promptly.

Please see the below list for other articles about Netiquette:

• owl.purdue.edu/owl/general_writing/academic_writing/email_etiquette_for_students
• chroniclevitae.com/news/964-dear-student-my-name-is-not-hey

Program Resources

Program Resources

Student Mailboxes (located in Graduate Student Office – Room 435)

Student Mailboxes are located in the Graduate Room and should be checked regularly for correspondence, returned assignments, and other items.

Personal Storage (located in Graduate Student Office – Room 435)

Lockers are available for your use during the fall and spring semesters. You may bring your own lock if you would like to better secure your items. Locker space is limited and available on a first-come, first serve basis.

• The department is not responsible for (and cannot guarantee) the safety of your personal belongings. No reimbursement shall be made on lost, damaged, or stolen items.
• Students are responsible for removing all personal items at the end of the semester (or as directed by the department). Left behind items may be removed and discarded. Items which cannot be retrieved dur to a forgotten lock may not be retrievable.

Kitchenette (Located in Graduate Student Office – Room 435)

Food and beverage are allowed in the Graduate Student Office, but any food-waste items are required to be disposed of in the hallway trashcans.

Amenities are available on a first come, first serve basis. Please note that most kitchenette amenities are donated items that may not be replaced if they are broken or if require excessive upkeep by the department. Students are responsible for maintaining this area and individual users are expected to clean up in the event that spills or splatters occur – failure to keep the area clean or to provide timely clean-up may result in removal of these items for an extended or permanent duration.

Video Cameras (Housed in Graduate Student Office – Room 435)

Video cameras and accessories can be reserved through use of the *Department Resource Schedule. These resources are limited, so check-out times cannot exceed 72-hour (3-day) periods. SD cards may be reserved for an additional 24 hours past camera check-out to allow for data-transfer to CD/DVDs (discs and instructions are available in the Graduate Room).

Printing Sensitive Documents (Education Building, 4^th floor)

Printing of sensitive information should occur only on the Education building fourth floor using your BroncoPrint account and student identification card. Appropriate consideration for your surroundings should always be given when printing documents (i.e. do not print the item/s if there is another person using the device, wait through the duration of the print job, and claim all printed items immediately).

• OIT offers limited free printing each semester with your student identification card.

Computers (Graduate Student Office, Live Supervision Room, and Other)

Desktop computers and laptops are available in department-approved work areas (“Blue Rooms”) and are available for use by students – however, work on confidential tasks (such as practicum videos) should always be given priority. Students working on non-confidential items (personal or academic/homework for other classes) must surrender the computer to those who need the space for confidential work. Laptops may be taken between approved workspaces, but are to remain within the department unless needed for class or for official department business (with prior approval to remove).

*Department Resource Schedule (Online Resource)

The *Department Resource Schedule is used to help students coordinate use of program resources. Please review Program Resources Section for policies around equipment checkout.

Reserving Space or Items

1. Log out of any personal email accounts (or use a new browser) before you begin
2. Log in to my.boisestate.edu
3. Access the *Department Resource Schedule document shared with you in the Google Drive (Department will grant access at start of year/semester)
4. Navigate to your desired sheet using the tabs at the bottom
5. Scroll through the document to locate an available space/device.
   Note that students can book use of the practicum labs throughout the day, but the practicum lab hours are highlighted in purple (only practicum students may utilize the lab at that time for appointments). Additional rules apply when booking space for practicum use. See the Practicum section of this handbook for full details.
6. Enter your full name into the appropriate cell. Do not change font or text-highlight of your entry.
7. Ensure that the auto-save feature has saved your entry before closing

Deleting Reservations of Space or Items:

1. Log out of any personal email accounts (or use a new browser) before you begin
2. Log in to my.boisestate.edu
3. Access the *Department Resource Schedule document shared with you in the Google Drive
4. Navigate to your desired sheet using the tabs at the bottom
5. Locate the reservation that needs to be removed (select box that contains your appointment)
6. Delete your entry by erasing your name
7. Ensure that the auto-save feature has saved this change before closing

Approved Work Areas

Access codes for approved work areas will be provided to students during Practicum/Internship classes, or are available through the Administrative Assistant.

Graduate Student Office (Room 435)

The Graduate Office is yours to use, but work on confidential practicum tasks is always given priority. Students working on non-practicum items (personal or academic/homework for other classes) must surrender space, computers, and other resources to those who need the space for confidential work. Office materials (writing utensils, paper, etc.) may be provided in limited quantities for practicum only. Kindly respect your fellow cohort members by keeping all materials in office and only using them for the appropriate/approved purposes.

Practicum students: Practicum USB drives and locked storage will be provided to each student for secure storage of client data.

Counselor Education Conference Room (433), Supervision Room (418) and Practicum Labs (427 A – D)

When not in use by supervisors, faculty, and/or staff, or otherwise occupied by appointment, the conference room is an acceptable work-space for students. Similarly, the supervision room and practicum labs may be used as workspace when not otherwise in use. Please be aware that the cameras in the labs are always on, even when not actively recording.

Restricted Work Areas (No work on confidential materials)

Hallways and Common Areas (Including Elevator Lobby)

Work on confidential information should never be conducted in hallways or common areas.

Main Office (Room 421)

The main office is open to students and visitors during office and practicum hours, but please note that phones and computers in this room are reserved for faculty/staff use only. Because this room is open to visitors, work on confidential paperwork (such as practicum session notes) is not allowed.

Restricted Access Rooms (Permission required for any use/access)

Copy Room

The copy room is typically not permitted for student use. Only in special circumstances and with explicit permission per each use may this room and any of the resources it contains be used by students.

Faculty Offices (430, 431, 432, 434, 436)

Faculty offices are considered off-limits to students, except when allowed by the individual faculty members by appointment or during office hours. These rooms are not to be used for student workspace.

Non-Department Rooms

Classrooms, workrooms, and offices managed by other groups/departments should not be accessed (excluding use of general purpose classrooms, when appropriate).

Faculty Endorsements (Recommendations)

During the course of graduate study in counseling, the student may have occasion to request letters of recommendation or endorsement from faculty members for various positions or opportunities. In keeping with both the ethical guidelines and the standards of the profession, faculty members will not knowingly provide an endorsement for any position or situation for which the student does not meet entry criteria. Faculty will include the internship site supervisor’s views in any position endorsement.

In no instance will a faculty member provide an endorsement for the student to enter a private practice situation other than in an appropriately supervised internship situation, which meets counseling program standards.

As a courtesy, the student should not ask that recommendations or endorsements be provided by faculty until the student has first checked with the faculty member. Exceptions to this procedure may frequently come in a blanket permission given at the end of a practicum or internship where a faculty member may say to an entire group of students, I would be willing to write a letter for any one of you. Usually, the faculty member has stated the limits of such recommendations in evaluation sessions with the student. In line with American Counseling Association (ACA) “Code of Ethics and Standards of Practice,” faculty will not support practice beyond the limits of the student’s abilities or qualifications.

The faculty will support the student enthusiastically in positions and activities for which faculty believe that the student is prepared.

Faculty who supervise Practicum will be asked to complete and sign a Verification of Supervision document for licensure in Idaho – and perhaps other similar documents for students moving to work in other States or countries. In such documents, faculty will have to note whether or not they have any reservations about the applicant being granted a license. Faculty will review students’ final evaluations for Practicum and consult with Internship supervisors as necessary before signing the document.

I. Self-disclosure and reflection:

A Masters Program in Counselor Education is unique because it blends academic rigor with personal growth. Just as professionals rely on tools such as computers to conduct their work, counselors rely on aspects of their “self” as an instrument to foster change and healing for clients. Therefore, some classroom instruction and assignments will require that you explore personal issues such as family history, strongly held convictions, intrapersonal strengths, and areas of growth. This work may challenge you to become more aware of your worldview, as well as deepen your ability to understand and be compassionate toward to the worldview of others

You will also be receiving supervision as part of your time with us as a student. Supervision takes place when you work with clients. The supervisory relationship is different from personal counseling; however, it includes unique features where you receive feedback that can feel uncomfortable and that you may disagree with at times. Feedback includes what you are doing well, as well as areas that can benefit from growth. It can be related to your thoughts, feelings, and behaviors in session or about professional issues at-large. Each supervisor has a unique style, and you will be expected to work with several different faculty members as well as practicing counselors serving as your supervisor. You will be expected to learn to receive and incorporate feedback into your work with clients. We understand that students enter our program displaying different levels of openness to growth; however, we believe that being receptive to feedback is a crucial aspect of counselor training and lifelong professional development.

II. General academic requirements:

Boise State University expects all graduate students to strive toward—and attain—academic excellence. If your academic performance is unsatisfactory, you may be withdrawn from the degree program by the Dean of the Graduate College, acting on the recommendation of your department.

To be eligible to receive a degree from the Graduate College, you must have a grade-point average (GPA) of 3.00 (“B”) or better in all graduate work specific to your program of study, and you cannot have a grade below a “C” in any individual course. You must receive a grade of “A” or “B” in a 300G or 400G-level course in order to count those credits toward your graduate degree. Finally, you cannot count grades below “C” to meet any requirement of a graduate degree program. A grade of “C-” or below will make you ineligible for graduation. It is your responsibility to communicate any grade below a “C” to your advisor.

If you are seeking a graduate degree and you earn a cumulative GPA of less than 3.00 for two consecutive semesters, you will be withdrawn from the graduate program and academically disqualified from any further graduate courses at Boise State University.

You will be expected to at a minimum maintain a GPA of 3.0. Additionally, if you obtain a “C” in Counseling Skills or Practicum, your continuing participation in our Program will be re-evaluated by your Program Advisor and Faculty. If allowed to continue, you will be required to re-take that course. This may slow your Program down one academic year. The same may be true of any other class you are required to re-take.

Additionally, students are expected to demonstrate competence in their cognate area (school counseling or addiction counseling) by meeting expectations in learning and skills as measured by key performance indicators (KPIs). If you obtain an unsatisfactory rating on a KPI, you will be required to complete a remediation for successful attainment of that outcome. Unsatisfactory ratings on more than one outcome may lead to a re-evaluation of your continuing participation in the Counseling Program by your Program Advisor and Faculty.

Most of our courses require that students write papers that often include reviewing scholarly literature pertinent to the counseling field, personal reflections, and self-exploration and insight. Most courses incorporate multiple-choice examinations, and some require that you record your clinical work with clients and/or practice of clinical skills with classmates. Our department has a digital recording system and provides lab space for this to occur for practicum.

Professional and personal growth-related issues are an important aspect of your grade in all courses. However, this is especially notable in practicum and internship where you are working with clients.

If needed, faculty will develop a personalized remediation plan with the intention of helping you acquire needed skills and/or maturity to succeed in the program. If you are displaying professional or personal issues that are a concern to faculty, your remediation plan may require personal counseling. You may also be required to slow down your program of study, which could result in delaying graduation. Although this is very rare and not expected, if students do not successfully complete their remediation plan, they could be advised out of the MA in Counseling Program.

III. Impact on relationships:

Because Counselor Education programs blend academic and personal growth, personal relationships may be impacted. You may expand how you think and feel in different areas, and this change could potentially impact relationship dynamics with those whom you are closest to. We expect that the impact will lead to positive outcomes such as more intimacy, better listening skills, and more compassionate communication. However, it could also result in conflict and disagreement that we hope is only temporary. We recommend that you seek support as needed through personal, couple, or family counseling. We also recommend that you rely on other social support networks you may already have in place if conflict arises.

Our program is based on a cohort model. If admitted, you will be with the same classmates in most courses and will likely form strong relationships. As with any other group experience, there is the potential for disagreement and conflict, as well as the development of close, supportive connections. Regardless of the nature of your relationships, we expect respect and professionalism in class with instructors and classmates and in supervision.

IV. Student rights:

As a student you have rights. You can appeal action taken by the program and/or the University. Please review our Student Handbook for detailed information. Also, please consult the Boise State website for more information.

V. General course information:

Many of our classes meet in the later portion of the afternoon and in the evening. However, sometimes meetings, supervision sessions, and courses are scheduled in the morning or early afternoon. Please understand that we cannot guarantee that we will not change times and dates of when courses have been offered in the past. Also, we have required weekend and summer courses. Attendance and punctuality are expected. Also, please note that we are a fully in-person program. You are expected to attend all class periods, supervision sessions, client sessions, and other required meetings in person.

We offer a Masters of Arts in Counseling program, and students must select to enroll in either the Addiction Counseling or School Counseling Cognate. Our curriculum comprises 60 credit hours of coursework, which includes practicum and internship, professional identity (core) courses, and specialty courses in your cognate area. Practicum requires 100 clock-hours over one semester and internship requires 700 clock-hours over two semesters (350 hours per semester) You must attend all required individual and group supervision sessions. This is a requirement for CACREP as well as for you to be eligible for licensure in the state of Idaho.

We do not recommend working full time and taking full-time credits as a graduate student when enrolled in a clinical sequence course (e.g. Practicum or Internship). Attempting to work the equivalent of two full-time jobs (full-time school + full time outside employment) can lead to mental fatigue, emotional exhaustion, and physical illness. These states are not conducive to learning and may result in impairment with clients. Successful students in the past have made difficult choices and/or engaged in creative planning so that they can maintain energy and capacity for school and clinical practice.

Both of our School and Addiction Counseling Cognates are CACREP accredited.

VI. Programmatic details:

You will be expected to attend a Mandatory Orientation that takes place once a year (typically in August). We also strongly recommend that you attend our Program Reception where we honor students who participate in our student organization and graduating students (typically in May).

You are required to submit a program Adjudication Statement at least once per year while in the program, meaning every year you are in the program. Information disclosed or otherwise obtained can impact faculty decisions regarding continuation in the program, endorsement by program faculty for students to enroll in practicum and/or internship, endorsement for any field-based placement, and/or disclosure by program faculty to potential internship and/or other field-based site or individual supervisors. Faculty may communicate with your supervisors (on and off campus) as needed and disclose information about your Adjudication Statement if it is in the best interest of clients. Faculty will always try to protect your privacy to the extent possible.

Admission to the program is not a guarantee that you will be able to secure clinical placements, which are required to complete the degree or become licensed and/or certified post-graduation.  Students with a felony criminal record who are admitted to the program may encounter difficulties securing clinical placements and/or becoming licensed and/or certified. Additionally, if you obtain a felony or a criminal record (e.g. a DUI) while in the program that could also impact your ability to obtain a clinical placement.

VII. Specific course information:

Some courses may include a service-learning or community components where you will have to schedule time outside of class to work face-to-face with individuals and/or families from culturally, racially, and/or religiously diverse backgrounds. Also, you will be expected to work with clients who may be of diverse sexual orientations.

VIII. Postgraduate Issues:

Although most (about 100%) of our graduates obtain employment in the field upon or shortly after graduation, we cannot guarantee that you will secure employment. Faculty will provide honest letters of recommendation and will support you in a reasonable manner.

We strongly recommend that you apply to become a Licensed Professional Counselor (LPC) upon graduation; however, licensure is not a requirement for graduation. Obtaining your license is a student responsibility. Please visit The Idaho Division of Occupational and Professional Licenses website for more information:

dopl.idaho.gov

In order to apply for licensure, you will be required to accrue additional clinical hours and pass the National Counselor Examination (NCE):

nbcc.org/exams/nce

Our Program will support these activities; however, licensure is your personal choice and responsibility. There are additional fees, unrelated to Boise State for obtaining licensure.

Additional credentialing such as Qualified Professional (QP) and CADC certification is OUTSIDE of the Program’s scope of responsibility. We encourage you to obtain as much information as possible and pursue licensure and certifications as you see needed. We often bring guest speakers to address these issues and alert you that state regulations change over time.

(Active Students will complete a digital version of this agreement throughout the program)

The following is a summary of the adjudication process for the Master of Arts in Counseling program at Boise State University. Students are provided with a link to the form as part of admission and/or orientation activities for the upcoming year.

In 2003 the College of Education determined that it is in the best interests of students to create a mechanism to determine the criminal history, if any, of the persons pursuing degrees in education.  In 2015 the Department of Counselor Education determined that additional information related to professional licensure, certification, and standing is also relevant to students pursuing a Masters in Arts in Counseling, and that such information may be considered and used by program faculty and officials to (a) make determinations regarding a student’s admission into the program, (b) discontinue students from the program, where necessary and appropriate, (c) determine whether program faculty will endorse students for practicum, internship, and/or any other field-based placement, and other purposes consistent with accreditation, student success, public safety, and program integrity. Furthermore, information regarding professional licensure, certification, and standing may be disclosed by program faculty to potential internship and/or any other filed-based placement sites or individual supervisors.

To the Student:

Professional counselors consider the welfare of the client above all else. As Counselor Educators, faculty have a duty to clients of counseling students, especially minor clients. The Department of Counselor Education requires all students to sign and submit the Adjudication Statement a minimum of three times:

(1) upon acceptance into the program

(2) prior to participating in the practicum experience

(3) prior to participating in internship

Additionally, students should complete the form:

(1) upon any updates or changes to answers previously provided on the form 

(2) at the start new academic year (if on a modified program, regardless of anticipated practicum or internship experiences) 

Information disclosed or otherwise obtained can determine faculty decisions regarding continuation in the program, endorsement by program faculty for students to enroll in practicum and/or internship, endorsement for any field-based placement, and disclosure by program faculty to potential internship and/or other field-based site or individual supervisors.

Adjudication Statement

I understand that before I may work with clients and/or students/minors through the Boise State University Department of Counselor Education, be placed in a practicum, field-based setting, or internship sponsored by Boise State, I must fully complete the statement below, sign, and submit this document to the Counselor Education Department, and to arrange a follow-up meeting with faculty should it be deemed necessary.

Part One:

• Have you ever been convicted, forfeited bond, received a withheld judgment or otherwise been adjudicated guilty in a court of law for any criminal offense, whether misdemeanor or felony, other than a minor traffic offense?

If Yes, the year of most recent occurrence is:

If yes, for each such adjudication or occurrence, please provide detailed information, including the charge or offense, the date of adjudication, and the name and location of the court or tribunal in which the case was adjudicated (you can attach a letter if additional space is needed):

Part Two:

• Have you ever had a professional license or certification revoked or not been in good standing with any professional board?

If Yes, the year of most recent occurrence is:

If yes, for each such occurrence, please provide detailed information, including the name and location of the board or association that took such action, the basis of the action, and a description of the outcome of such proceeding.

Part Three:

If you answered yes to either question, have you already met with faculty for an in-depth discussion about this matter?

If Yes, the year of most recent occurrence is:

Part Four:

If you answered “Yes” to either question and have not previously met to discuss the events specified on this form, you must contact your Cohort Advisor for an appointment. You may not work with clients or be placed in a school until you have met with your Advisor and the Department Chair to determine your suitability for this work. If you do not agree with the outcome, you may appeal to the College of Education Professional Standards Committee.

Part Five:

I understand that falsifying information on this and/or any application forms for the Boise State University Counselor Education Program may cause my application for acceptance or for continuance in a counseling degree program to be denied or revoked.  Additionally, I understand that what I disclose on this form may impact my admission status, continuation in the program, enrollment in practicum, internship, and/or any other field-based placement. Furthermore, I understand that program faculty may determine it is necessary to disclose information provided on this form or otherwise obtained by faculty and/or staff to potential internship and/or other field-based placement site or individual supervisors, and I expressly consent to such disclosure.

I hereby further agree to promptly notify program officials if, after execution of this form, I am charged with a crime and/or any action is taken against any professional license or certification I possess, and to provide complete and accurate information regarding any such occurrences. I understand and agree that future occurrences may likewise affect my standing in the program, including external placements, and understand that my failure to promptly notify program officials of such may result in my dismissal from the program.