UNIVERSITY OF MASSACHUSETTS
AMHERST
voice: 413.545.2526
fax:
413.545.1645
www.umass.edu/sphhs
School of Public Health and Health Sciences
Arnold House
715 North Pleasant Street
Amherst, MA 01003-9304
Practicum Contact Hour Log
School of Public Health & Health Sciences
University of Massachusetts, Amherst
The purpose of this log is for you and your Practicum Site Supervisor to make sure you are completing
your practicum hours in a timely way. Please submit this to the SPHHS Practicum Coordinator.
Student Name______________________
DATE
# hours worked
Subtotal:
DATE
# hours worked
Subtotal
Total Hours (columns 2+4)_______
Student signature:____________________________
Site Supervisor Signature:___________________________________
Submit the completed form to the SPHHS Practicum Coordinator
9/25/08