Internship Hours Log

INTERNSHIP HOURS LOG

Internship Site:

Student's Name:

include workshops, phone calls/emails, patient write ups/treatment plans, outreach and

Indirect Hours

reading site materials.

Direct Hours

include client contact (Individual, group, family, etc.). Also includes any shadowing work done with

the site staff that involves that involves providing services to a client.

Supervision

includes 1 x 1or group supervision on-site.

Month:

Date Worked

Day of the week

Indirect

Direct

Supervision

Total

Supervisor's Signature:

Date:

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Parent category: Miscellaneous