60 Hour/Monthly Summary Reports Post University HSV: Human Services Field Practicum I & II…

60 Hour/Monthly Summary Reports  Post
University
HSV: Human Services Field Practicum I & II
Monthly Summary Reports

Please
type this report. Select up to 2-4
activities and describe in detail how they connect to the learning goal address
in the last column. Feel free to attach
an additional page to complete this form.
Indicate the month these activities were performed and indicate the
hours worked. A minimum of 2 outside resources is required for
each report.

Student
name:

Month Hours worked
Hours of supervisory contact

Summary of
worked performed / learning opportunities:

Briefly
Describe Activity

Population(s)
Served

Frequency
of Activity

Learning
Goal Addressed (#)

1.

2.

Summary of
worked performed / learning opportunities:

Briefly
Describe Activity

Population(s)
Served

Frequency
of Activity

Learning
Goal Addressed (#)

3.

4.

Additional
comments/observations:

Student
signature:

Date:

Supervisor
signature:

Date: