Supervisee's Signature____________________________________________
Month/Year ________________
ALPS's Signature ______________________________________________
Individu
al
Grou
p
Fam
ily
Counseling
Screening/
Intake/
Cris
is
ALPS
Date
Consultation
Case Mgt.
TOTAL
Counseli
ng
Counse
ling
Coun
seling
Related
Assessment
diagnostic
Interven
tion
Supervision
Mon.
Tues.
Wed.
Thur.
Fri.
Mon.
Tues.
Wed.
Thurs.
Fri.
Mon.
Tues.
Wed.
Thurs.
Fri.
Mon.
Tues.
Wed.
Thurs.
Fri.
Mon.
Tues.
Wed.
Thurs.
Fri.
TOTAL:
Daily/Weekly Log Sheet for a Supervised Counselor
Daily/Weekly Log Sheet for a Supervised Counselor