Intern/Trainee Agreement

Intern/Trainee Agreement

Welcome to Mariposa! We are excited to have you join our clinical team and we are looking forward to working with you. Your association with Mariposa Women & Family Center is voluntarily entered into and services can be terminated “at will” by either party. If you choose to terminate this association, Mariposa requests that you give AT LEAST ONE MONTH’S NOTICE in writing to the Program Director, Program Manager, or Program Coordinator and your Clinical Supervisor. This is to ensure that there is time to complete the termination process with your clients or transition them to another counselor. Counselors are required to work 20 hours per week unless otherwise informed. Your schedule below must reflect this unless otherwise approved by the Program Director/Manager
Name

First NameLast Name
Email
example@example.com
I have agreed to work this many clinical hours per week:
My availability will be specified below.
Monday
Tuesday
Wednesday
Thursday
Friday
Initials Agreeing to be On Site:
I understand that I am agreeing to be on site at these available times. If I do not have clients scheduled for the total duration of my daily schedule, I will seek out other tasks to assist with within the agency. I will seek guidance from the Program Director/Manager, Clinical Supervisor, Field Instructor, and/or Preceptor on any additional projects and tasks to be completed.
Initials Agreeing to Complete All Clinical Documentation w/in 48 hours:
I agree to complete all required clinical documentation within 48 hours following a client session, be compliant with all agency policies and procedures, and to communicate any changes to my schedule with the Program Director, Program Manager, or Program Coordinator, Clinical Supervisor/Field Instructor and the Intake Department.
Initials Agreeing to Check Agency Voicemail:
I agree that as part of the clinical team at Mariposa I am required to check my agency voicemail and email on a regular basis and to respond to all company requests within 48 hours.(Regular basis constitutes two times weekly at minimum.)
Initials Agreeing to Professional Behavior:
I understand that I am expected to be professional and courteous with other staff and clients at all times. I am expected to dress in professional attire and to practice professional conduct guidelines while at Mariposa.
Initials Agreeing to Year-long Commitment:
I understand that Mariposa requires me to make a year-long commitment (or academic year commitment for MSW Graduate Students) as part of the clinical team. I agree that I am not to schedule time off without prior notification and without submitting the proper paperwork. All trainees and Interns are allowed 10 days off during their one year commitment at Mariposa. Special arrangements must be made for additional time off. Please see Attendance Policy and Procedures for more details.
Initials Agreeing to GGUSD Placement Requirements:
I understand that if I am placed in the school-based program at GGUSD, I am required to stay for the full GGUSD academic year, regardless of the end date of my university end of placement date.
Initials Agreeing to GGUSD Weekly Hours Requirement:
I understand that if I am placed in the school-based program at GGUSD, I am required to complete the agreed upon hours per week at the assigned GGUSD school, any missed (including calling out) hours will need to be made up on a different day (preferably within the same week).
Initials Agreeing to GGUSD Timesheet Requirement:
I understand that if I am placed in the school-based program at GGUSD, I am required to complete timesheets and adhere to the deadlines for timely submission to the school district.
Initials Agreeing to Span of Internship Duties:
As an MSW student, I understand that my clinical internship hours may include help with intake, phone screenings, child care, etc., during my placement with Mariposa. I understand that as part of my commitment to Mariposa I am expected to help at special events, fundraisers, workshops, etc.as part of my internship hours.
Initials Agreeing to Additional 20-hour Commitment:
As an MFT Trainee, MFT/MSW Registered Associate or PsyD interns, I understand that in addition to my clinical internship hours I am required to make an extra 20 hour commitment to help with child care, phone screenings, volunteer at internal and/or external special events, fundraisers, workshops, etc. during my year- long internship at Mariposa.
Initials Agreeing to Attendance Requirement:
I will attend all scheduled supervision sessions, program meetings, all required regularly scheduled Agency meetings and trainings in person or remotely. In addition, I will be on time for all meetings and clinical sessions at Mariposa Women & Family Center. Excessively missing meetings or tardiness (meetings and client sessions) may lead to my dismissal from my volunteer assignment with Mariposa.
Initials Agreeing to Caseload Requirements:
MFT Trainee, MFT/MSW Registered Associate or PsyD interns are expected to carry a minimum of 12 active clients on their case load for the duration of their placement at Mariposa. MSW Interns caseload will be reflective of their program placement. (After 3 consecutive missed sessions clients are to be considered for discharge and are no longer considered “active.”)
Initials Agreeing to CEO Approval for Additional Caseload:
I understand that accepting clients above the indicated level MUST be approved by the CEO.
If I am unable to meet ALL the expectations noted in this agreement, my position at Mariposa may be forfeited at the discretion of the Program Director, Program Manager or Program Coordinator, in collaboration with my Clinical Supervisor.
Print Your Name One More Time:
Intern/Trainee Signature and Date:

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Program Director/Field Instructor Signature and Date

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Should be Empty: