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Stage 1 Form 2 MHC/SGC

Graduate Program in Counseling

Stage 1 Review for Candidacy

Student Name____________________________ ID: @____________

Required Attachments for

Address_______________________________________________________

Counseling Office Folder:

__ FSU Transcript to date

Town/City: ________________________________ State_____ Zip_______

__ Candidacy Statement

Disposition Assessments:

__Counseling Theories*

Telephone: ___________________ Email:____________________________

__Intro Prof. Counseling*

__Additional for CAGS*

Check program and concentration below:

*SGC: Advisor sends to

Program:

Masters of Science

CAGS - IS

licensure office.

Concentration/direction: □ MS: MHC

□ CAGS: MHC

□ MS: SGC

□ CAGS: SGC

University Admissions Date: __/__/__

Credits Completed to Date: _________

Requirements

Yes

(Note next action step)

1. Completed the Stage 1 required courses (Counseling

Techniques and Intro Prof Counseling; two courses

for CAGS students).

2. 3.0 minimum overall cumulative average.

3. Stage 1 minimum 3.0 final grades in each course.

4. Demonstrates appropriate ethical behavior

(Candidacy Statement and Candidate Dispositions

Assessments from courses).

5. Demonstrates competent interpersonal behaviors

(e.g., with peers, faculty, supervisors, clients) as

noted in Candidacy Statement and Field Experience

Evaluations.

6. Demonstrates effective writing and oral

communications skills as evidenced in Candidacy

Statement and Field Experience Evaluations.

Advisor’s Recommendation:

__Award Candidacy

__ Consultation with Graduate Counseling Programs Committee

Advisor’s Signature_______________________________________________ _______________Date:___/___/__

Graduate Counseling Programs Committee Recommendation:

__ Award Candidacy

__ Candidacy is not awarded at this time. Student needs to take the specific courses to demonstrate competencies

(Provide course number and title):____________________________________________________________

__ Other (Specify):______________________________________________________________________________

__Drop from the Program

Graduate Counseling Chair__________________________________________________

Date:___/___/__

Dean of Education action for formal admission to the Fitchburg State University Educator

Preparation Program

(for students in School Guidance Counseling Course of Study): __ Award Admission

__Deny Admission

(Reason):_______________________________________________________________

Signature of the Dean of Education or Designee:____________________________________ Date:___/___/___

MHC students: Retain original document for future licensure application. 2 copies to Advisor.

SGC students: White (licensure) and yellow copies to program advisor; pink copy for student

records.

9/13

Graduate Program In Counseling Stage 1 Review For Candidacy Form - Fitchburg State University

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