Fillable Weekly Supervision Hours Log-MSW.9.22.16

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Weekly Supervision Hours Log-MSW.9.22.16

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Monday
: _______________
am/pm To _________________am/pm Tuesday: _________________ am/pm To _________________
Wednesday: _____________ am/pm To _________________ am/pm Thursday: ________________ am/pm To _________________
Friday: _________________ am/pm To __________________ am/pm
Fall Semester _______ Spring Semester _______
Missed days/hours ___________________________ Date/time (s) for makeup _____________________ Total Hours to Date: ________________
Additional approved activities/hours: ________________________________________________________________________________________
_____________________________________________________________________________________________________________________
CS
UF Liaison Contacted __________________________ Date: ________________ Corrective Action Plan Date: _________________
Fresno State
Department of Social Work Education
Weekly Individual Supervision & Internship Hours Log
MSW Social Work Intern for week of: __________________________________________
Supervision Agenda – to be prepared in advanced by student intern
Assignment (see learning agreement)
Disposition/Current Status:
1.
2.
3.
4.
5.
6.
7.
Topic(s) for Discussion:
Revi
ew of Assigned Cases:
Integr
ation of theory with field practice (systems, empowerment, learning and conflict theories)
Questions/Concerns:
________________________________ ______________ ___________________________________ _____________________
Student Signature Date Field Instructor Signature Date
Revised 9/16
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Weekly Supervision Hours Log-MSW.9.22.16

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Completed 29 May 2020

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