Monthly Supervision Log
George Fox University School of Social Work
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Name of Student: ___________________________________Month: ______________________
Dates and times of supervision:
Date
Start
Time
End
Time
Individuals Present
Month Total
Semester Total
Student Signature: ______________________________
Date: __________________
Field Instructor Signature: _______________________ Date: __________________
Daily Total
Student Supervision Report Form
George Fox University School of Social Work
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Each supervision session students should complete this form to prepare for the
supervision session and to reflect on issues discussed in supervision. At the end of
the month the student will attach them to the cover page log and submit the signed
copies to the field faculty.
Session #
Date:
Prior to Supervision Session:
Identify 2- 3 issues that are areas of concern, growth, and development you
wish to discuss in supervision this week.
If you have specific questions about a case, theory, ethical dilemma, or other
area of practice, please write them here (attending to confidentiality
guidelines of the agency and the School of Social Work.)
Reflection on supervision session:
What are your top 2-3 learning points you have taken away from this session?
What are areas of focus for future supervision session?
Student Signature: __________________________
Date: _________________