Monthly Activity Report April 2012

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					                      April 2012
     STUDENT MONTHLY PRACTICUM ACTIVITY REPORT
                                       KENT SCHOOL OF SOCIAL WORK
                                                        University of Louisville
Student
Faculty Field Liaison
Check Course:           SW670/671 Foundation/Generalist                    SW672/673 Advanced Practice
Agency
The student completes this form monthly, and submits to her/his Faculty Field Liaison by the 7th
of each month. Record the time you spend each week, in each category, to the closest half-hour.
                                                               Apr. 1-Apr. 7     Apr. 8-14   Apr. 15-21    Apr. 22-23


 I. Direct Service to
    Individuals/Couples/Families
    (student as leader/co-facilitator of educational,
    support, or therapy sessions)
 II. Direct Service to Groups
    (student as leader/co-facilitator of educational,
     support, or therapy groups)


 III.Indirect Service/Administrative Activities
    (planning, coordinating, budgeting, policy
    development, community organizing, research,
    committee meetings)

 IV. Formal Supervision
    (formal face to face time with practicum supervisor
    for reflection on social work practice; NOT
    shadowing or informal supervision)

 V. Other (please explain)


 VI. Weekly Total Hours

 VII. Total Cumulative Hours from Previous                     VIII. Total Hours             IX. Grand Total
 Month                                                         this Month                    Cumulative Hours to
                                                                                             Date (expected 225 hrs.)


Ethnicity of clients assigned this month:_                    %African American              % Asian               % Caucasian

       % Hispanic              % Native American Indian                        % Bi-racial        % Other
Gender of clients assigned this month:                      % Female              % Male         Age range of clients:


Number of clients assigned this month:                                 Number of groups assigned this month:

STUDENT:
               Print Name and Sign                                                                          Date
PRACTICUM SUPERVISOR
                                     Print Name and Sign                                                    Date
FACULTY LIAISON:
                           Print Name and Sign                                                              Date
Page 2 April 2012
Student Monthly Activity Report
Kent School of Social Work, University of Louisville

I. Discuss what you learned in your campus classroom courses this past month and describe how
that learning applies in your practicum:

Practice Class   SW 605(Foundation) or          SW 677(Advanced) or         SW 701(Marriage &
Family Therapy):

Other Classes, please identify:



II. Describe how your practicum activities this month relate to your Learning Objectives:

				
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