Please check only Course and Program one one Directions: Course Program Practicum Mental Health Counseling - Clinical Internship I Mental Health Counseling - Rehabilitation Internship II School Counseling PhD RCRCE Student Name: Site: Indirect Direct Hours Hours Date Activity Description of Activity Weekly Totals Cumulative Cumulative Cumulative Indirect Hours Direct Hours Total Hours Signature of Site Supervisor: _______________________________________ Date: _______________ Signature of Student: ____________________________________________ Date: _______________
Directions: Please check only one Course and one Program Course Program Practicum Mental Health Counseling - Clinical Internship I Mental Health Counseling - Rehabilitation Internship II School Counseling PhD RCRCE Student Name: Site: Date Activity Description of Activity Indirect Hours Direct Hours Weekly Totals Cumulative Indirect Hours Cumulative Direct Hours Cumulative Total Hours Signature of Site Supervisor: _______________________________________ Date: _______________ Signature of Student: ____________________________________________ Date: _______________