ORAL ROBERTS UNIVERSITY Graduate School of Theology and Ministry Master of Arts in Christian Counseling LPC/LMFT Practicum and Internship Program RECORD OF SUPERVISED EXPERIENCE Student Name (print): _________________________________________________________________ Site Supervisor Name (print): __________________________________________________________ Semester/Year __________________Practicum _______Internship I _______Internship 2 _________ Week Date(s) Met with Total Number of Total Number of Total Number of Beginning Supervisor Face-to-Face Direct Client Supervised Date Supervision Hours Contact Hours Experience Hours (GRP) (TRI) (IND) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Hours Student Intern Signature: _______________________________________ Date: __________________ Site Supervisor Signature: _______________________________________ Date: __________________
ORAL ROBERTS UNIVERSITY Graduate School of Theology and Ministry Master of Arts in Christian Counseling LPC/LMFT Practicum and Internship Program RECORD OF SUPERVISED EXPERIENCE Student Name (print): _________________________________________________________________ Site Supervisor Name (print): __________________________________________________________ Semester/Year __________________Practicum _______Internship I _______Internship 2 _________ Week Beginning Date Date(s) Met with Supervisor Total Number of Face-to-Face Supervision Hours (GRP) (TRI) (IND) Total Number of Direct Client Contact Hours Total Number of Supervised Experience Hours 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Hours Student Intern Signature: _______________________________________ Date: __________________ Site Supervisor Signature: _______________________________________ Date: __________________
Record%20of%20Supervised%20Experience,%201-17-17.docx