MAJOR CASE STUDY SHEET
(to be completed by FFA for all case studies and returned to the School)
Date: _______________
Faculty Field Advisor: __________________________ Focus: _________________________
Identifying Client Information
Age: _____
Race/Ethnicity: ________________
Citizenship: ____________
Gender: _______
Religion: _____________________
Social Class: ___________
Sexual Orientation: _________________________
Facility: _________________________
Modality: __________________________
Duration of Intervention: ____________________
Mode of Intervention: __________
Presenting Problems: ___________________________________________________________
Diagnostic: ___________________________________________________________________
Major Themes/Issues: ___________________________________________________________
How Services were Funded: ______________________________________________________
Education & Usage: ___________________
Summary of Case: (please limit to one paragraph)
Grade (circle one): P
MP
F
Evaluation of Case Study’s Potential use for Teaching :
Excellent ____
Very Good ____ Fair _____ Poor _____
Identifying Student Information:
Author’s Name: __________________
Author’s Race/Ethnicity: ___________
Placement Year:
1st
2nd
FOR OFFICE USE ONLY
Student’s approval obtained: _________
Date: _________
When Used: _______________________
When Used: _______________________
When Used: _______________________
Course: _________________________
Course: _________________________
Course: _________________________
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