SAMPLE Jame Smith 12 Name: Semester: Fall Spring Summer 20 The Counseling Agency Dr. Connie Psychologist Site: Supervisor Name: SEMESTER LOG: YEARLY LOG: Add totals from EACH timesheet pages to find this Input semester totals to determine semester’s total. progress towards completion. 7 Semester Client Sup. Other Totals: Hours: Hours: Learning 3 Hours : 3 Fall 58 12 101 2 Spring 69 15 112 Supervisor 15 Summer Totals: 127 27 213 33 11 15 Hours Towards Totals: Completion: 10 Client Direct Client 27 69 40 Supervision 127 22 Other Learning 213 30 Hours: 20 Total: 367 Other Learning Hours: 112 Signed (Student): Jane Smith Date: April 12, 2012 Dr. Connie Psychologist Signed (Supervisor): Date: April 12, 2012 ____ Lampson, Ph.D. April 12, 2012 Signed (DCT): ________Kim Date:
SAMPLE Name: Jame Smith Semester: Fall Spring Summer 20 12 Site: The Counseling Agency Supervisor Name: Dr. Connie Psychologist SEMESTER LOG: YEARLY LOG: Add totals from EACH timesheet pages to find this Input semester totals to determine semester’s total. progress towards completion. 7 3 3 2 15 Semester Totals: Client Hours: Sup. Hours: Other Learning Hours : Fall 58 12 101 Spring 69 15 112 Summer Totals: 127 27 213 Supervisor 33 11 15 10 69 Hours Towards Completion: Totals: Direct Client 27 Supervision 127 Other Learning Hours: 213 Total: 367 Client 40 22 30 20 112 Other Learning Hours: Signed (Student): Jane Smith Date: April 12, 2012 Signed (Supervisor): Dr. Connie Psychologist Date: April 12, 2012 Signed (DCT): ________Kim Lampson, Ph.D. ____ Date: April 12, 2012
2012-2013-Practicum-Handbook_FINAL_8_30_2012.docx