Masters of Arts in Counseling
CLINICAL MENTAL HEALTH COUNSELING
PRACTICUM (COUN 580) WEEKLY SUMMARY LOG
Week #
Date Week Begins
Direct Service
Total On-Site Hours this Week
Time
Spent
Indirect Service
Individual
Co-Counseling/Counseling
Group
Co-Counseling/Counseling
Family
Co-Counseling/Counseling
Intake Interviewing
Staff/Team Meetings
Testing/Assessment
On-Site Supervision
Professional Consultation
Training
Other (list)
Other (list)
Total Direct Hours
Total Indirect Hours
Diverse Background
Diverse Background
Disability
Disability
Time
Spent
Record Keeping
Treatment Planning
Case Conferences
All my clients have signed the Messiah College informed consent form
student’s initials
Site Supervisor (please print)
Site Supervisor Signature
Date
I acknowledge that checking this box electronically serves the same purpose as affixing
my original signature to this document.
Practicum Student (please print)
Practicum Student Signature
Date
I acknowledge that checking this box electronically serves the same purpose as affixing
my original signature to this document.