Practicum Interest Application

Ackerman Institute for the Family is an OMH-licensed Article 31 clinic and operates under strict professional and ethical standards.

If accepted, I agree to:

Practicum Expectations & Clinical Hour Commitment

As a practicum trainee at the Ackerman Institute for the Family, I understand and agree to:

• Maintain consistent attendance and active engagement in supervision and training.
• Comply with all federal, state, HIPAA, OMH, and Institute confidentiality regulations.
• Complete all required compliance training prior to client contact.
• Use approved Institute systems for documentation and communication.
• Complete clinical documentation within required timeframes.
• Practice within the scope defined by my academic program and the Institute’s supervision structure.
• Participate in live and/or recorded supervision as required by the training model.

Clinical Hour Requirement

Eligibility Attestation

Certification

I certify that the information provided is accurate to the best of my knowledge.