Fillable CWA-Hours-Log.PPS - CWA Hours Log _2_

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CWA-Hours-Log.PPS - CWA Hours Log _2_

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CALIFORNIA STATE UNIVERSITY, FRESNO
Department of Social Work Education
Pupil Personnel Services Credential Program
Hours Log for CWA Hours Outside of Education
PPS Candidate:
Field Instructor Name:
Faculty Liaison Name:
PPS Field Placement: ________________________________________________
Please document field experience hours outside of the field of education by completing the
information in each column. Complete a separate sheet for each separate experience. This
information will be retained with the field instructor’s records and submitted with the final PPS
Evaluation of Student Performance in May.
DATE AGENCY CONTACT
PERSON
HOURS
COMPLETED
Brief Description of Agency Experience:
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I verify that the hours documented above have been completed by this PPS candidate:
Agency Rep. Signature: _______________________________________ Date: _____________
Job Title: _________________________________________________ Date: _____________
PPS Candidate Signature: _____________________________________ Date: _____________
Field Instructor Signature: _____________________________________ Date: _____________
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Completed 1 June 2020

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