II. ACTIVITY REPORT: Describe and assess your performance at your internship site this week by
responding to the following questions. Please be as specific as you can. Attach the one-page Weekly Log
(Excel format) to this two-page Activity Report.
A. What were you expected to do this week? In other words, what learning objectives and corresponding tasks
for this week did you and your supervisor discuss and agree to? How were any of these objectives and tasks
different from 1 or 2 weeks ago?
B. What two things did you learn this week (from a client, supervisor, and colleague) about the practice of
counseling or your role as a counselor trainee/intern? Provide examples.
C. How will you apply in the near future what you learned this week?
D. Assess your overall performance for this week. Please provide specific examples.
KSU Clinical Mental Health Counseling Internship Log and Activity Report
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E. What skills do you need to work on? What tasks do you need to undertake?
III. Internship Concerns:
Indicate any placement-related problems that you are experiencing. What steps have you now taken to resolve
the problem? Is your site supervisor aware of this problem?
Please indicate any matter that you feel requires the assistance of the internship instructor.
IV. Site/Clinical Supervisor’s Initials: ______________ Date:_______________
 Yes, I have reviewed this week’s Activity Report and Log completed by the Clinical Mental Health
Counseling Intern.
 I request a phone call or a meeting with the KSU Clinical Mental Health Counseling Internship
Instructor or Internship Coordinator to discuss questions and/or concerns I have about this student’s
internship.
KSU Clinical Mental Health Counseling Internship Log and Activity Report
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