Prairie View A&M University
Division of Social Work Behavioral and Political Sciences
Bachelor of Arts in Social Work Education
Field Instruction Assignment Time Sheet
Agency Name
Phone
Address
City
State
Zip
SOWK 4183: Integrative Seminar
Date
Monday
Time IN
Tuesday
Time OUT Time IN
Wednesday
Time OUT Time IN
Thursday
Time OUT Time IN
Friday
Time OUT Time IN
Saturday
Time OUT Time IN
Sunday
Time OUT Time IN
Time OUT
Total
Hours
(Week)
Total
Hours
To Date
From
To
Example
1/3/2016
1/9/2016
8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m.
---------
---------
---------
---------
16
16
Example
1/10/2016
1/16/2016
8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m. 8:00 a.m. 5:00 p.m.
---------
---------
---------
---------
30
46
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12
Total Hours
Agency Official's Name (Print)
Agency Official's Signature
Student's Name (Print)
Student's Signature