Practicum Log of Hours and Activities by 5ydj7X

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									                                                                  School of Social Work
                                                                 Office of Field Education

                                                  Log of Practicum Hours and Learning Activities

               Name:__________________________________________                       Banner ID #            ________________________________

               Semester: _____________ Year: ___________________                     Faculty Liaison        ________________________________

               Practicum Site: __________________________________                    Practicum:       481                482                 821           822
                                                                                                     BSSW               BSSW               Foundation   1st concentration


                                                                                                      823                824                 825
                                                                                                  2nd concentration   3rdt concentration    Elective

This is an important record of your work and time spent in your practicum course. This form has several uses. It provides you with an on-going accounting of
hours and a brief history of your practicum learning activities. In addition, it is required in order to certify your educational practicum time for your degree
and to the social work education accrediting body, The Council on Social Work Education (CSWE).
Please note:
This hours and activity log must be signed by you and your field instructor upon completion of the practicum and turned in with your final
evaluation in order to receive a course grade.

Instructions:
Briefly record your practicum activities for the day and the hours in practicum on a weekly basis. Clearly indicate your one hour of supervision on the weekly
recording AND document the content on the Supervision Content section of the form. Plan to round hours to the nearest 15 minutes or .25 of an hour. Time
spent in the practicum includes all of time at the site as well as any practicum related activity such as traveling to home visits or meetings. Your travel time to
the site and home DOES NOT count. Practicum hours may be counted for time conducting research or working on projects that is performed off-site but must
be very limited to no more than 30 hours of the 240 required. In addition, any off-site work must have products or an outcome related to a learning objective.
Any concerns or exceptions should be discussed with your faculty liaison. As a part of all professional practice, this is guided by the School of Social Work’s
policy on academic integrity and the NASW Code of Ethics which require an honest and accurate reflection of your practicum work and time.
                                                                    ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦
Week            Learning             Learning             Learning            Learning             Learning              Learning         Supervision Time     Total       Total
                                                                                                                                                              Hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities        Documentation     for Week     Hours
   1        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




   2        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______
(Week of)




   3        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   :
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




                                                                                                                                                             *Indicate
                                                                                                                                                             hours
                                                                                                                                                             worked
                                                                                                                                                             off-site
                                                                                                                                                             with an *
Week            Learning             Learning             Learning            Learning             Learning              Learning              Supervision      Total      Total
                                                                                                                                                               Hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities               Time        for Week    Hours
                                                                                                                                              Documentation
   4        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   :
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




   5        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   :
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




   6        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   :
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)


                                                                                                                                                              *Indicate
                                                                                                                                                              hours
                                                                                                                                                              worked
                                                                                                                                                              off-site
                                                                                                                                                              with an*
Week            Learning             Learning             Learning            Learning             Learning              Learning          Supervision      Total      Total
                                                                                                                                                           Hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities           Time        for Week    Hours
                                                                                                                                          Documentation
   7        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




   8        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




   9        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




                                                                                                                                                          *Indicate
                                                                                                                                                          hours
                                                                                                                                                          worked
                                                                                                                                                          off-site
                                                                                                                                                          with an*
Week            Learning             Learning             Learning            Learning             Learning              Learning          Supervision      Total      Total
                                                                                                                                                           Hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities           Time        for Week    Hours
                                                                                                                                          Documentation
   10       Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




  11        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




  12        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




                                                                                                                                                          *Indicate
                                                                                                                                                          hours
                                                                                                                                                          worked
                                                                                                                                                          off-site
                                                                                                                                                          with an*
Week            Learning             Learning             Learning            Learning             Learning              Learning          Supervision      Total      Total
                                                                                                                                                           Hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities           Time        for Week    Hours
                                                                                                                                          Documentation
   13       Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




   14       Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______
 _____
(Week of)




  15        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




                                                                                                                                                          *Indicate
                                                                                                                                                          hours
                                                                                                                                                          worked
                                                                                                                                                          off-site
                                                                                                                                                          with an*
Week            Learning             Learning             Learning            Learning             Learning              Learning          Supervision      Total      Total
                                                                                                                                                           Hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities           Time        for Week    Hours
                                                                                                                                          Documentation
   16       Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




  17        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




  18        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




                                                                                                                                                          *Indicate
                                                                                                                                                          hours
                                                                                                                                                          worked
                                                                                                                                                          off-site
                                                                                                                                                          with an*
Week            Learning             Learning             Learning            Learning             Learning              Learning          Supervision      Total      Total
                                                                                                                                                           hours*     Semester
                Activities           Activities           Activities          Activities           Activities            Activities           Time        for Week    Hours
                                                                                                                                          Documentation
   19       Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




  20        Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______   Day of week_______
            # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______   # of hours _______

(Week of)




                                                                                                                                                          *Indicate
                                                                                                                                                          hours
                                                                                                                                                          worked
                                                                                                                                                          off-site
                                                                                                                                                          with an*
                                                                   Supervision Content Documentation

Instructions to students: Complete the following chart for each week of your practicum. Document the date of supervision, time it occurred, two or more bullet points
         about topics discussed, and the learning objective number(s) to which the topics relate. Document planned follow-up to the supervision session in the last column.

         Date                     Time                    Topic(s) Discussed           Related Learning Objective           Follow-up to Supervision

                1

            (Week of)

                2

            (Week of)

                3

            (Week of)

                4

            (Week of)

                5

            (Week of)

                6

            (Week of)

                7

            (Week of)

                8

            (Week of)

                9

            (Week of)
Date          Time   Topic(s) Discussed   Related Learning Objective   Follow-up to Supervision



       10

  (Week of)

       11

  (Week of)

       12

  (Week of)

       13

  (Week of)

       14

  (Week of)

       15

  (Week of)

       16

  (Week of)

       17

  (Week of)

       18

  (Week of)

       19

  (Week of)
   Date                 Time                 Topic(s) Discussed         Related Learning Objective        Follow-up to Supervision

          20

      (Week of)


Our signatures attest that this documentation represents an accurate accounting of the activities, time spent and supervision time and content
                                                              in this practicum.


                          ____________________________________           +    ____________________________=           240 hours
                                   Total Activity Time                           Total Supervision Time

                      ____________________________________               __________________________________
Form Revised 7/1/09            Student Signature / Date                        Field Instructor Signature / Date

								
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