Your Name:

Semester:

Emily DeWitt

Site Name:
Site Supervisor
Name:

West Fairmont Middle School

Lisa Boyle

Spring

Year

2016

Total Direct Hours

180

165.34

160
140

121.42

120
100
80
60
40

20.5

20
0

0.5
0

12.176.75
2.5

1.5
0

361

Total Hours:

Total Indirect Hours

165.34

.75

250

195.88

200
150
100
50
0

43.25

33.7531.41

25.08 17.5

8.08
0

31.9
1.91

Dashboard
WK 1
WK 2
WK 3
WK 4

WK 5
WK 6
WK 7
195.88 WK 8
WK 9
WK 10
WK 11
WK 12
WK 13
WK 14
31.9
WK 15
WK 16
WK 17

Weekly and Cumulative Log of Internsh

Week Ending: 1/17/2016
DIRECT Activity

TUES

WED

THURS

1.25

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

MON

Name:

0.75
0.5

2
0.33

0.33
0.58
3.83
6.07

7.32

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

0.75
0.5
1.25

FRID

SAT

SUN Week TotalTOTAL to Date

0
0
0.75
0.5
0
0
0
0
0
0
0
0.75
0.5
2.5

0
0
0.75
0.5
0
0
0
0
0
0
0
0.75
0.5

2.5

SUN Week TotalTOTAL to Date

0.75

1
6.33

1.75
2
0
4.33
0
0
0.33
0
1.16
0
4.83
14.4

7.58

16.9

0.58

1.75
2
0
4.33
0
0
0.33
0
1.16
0
4.83

14.4

16.9

Weekly and Cumulative Log of Internsh

Week Ending: 1/24/2016
DIRECT Activity

MON

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

INDIRECT Activity

MON

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

TUES

Name:
WED

THURS

1.25

1.25
2.5

TUES

WED

THURS

1.75

1.25
3

5.5

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

FRID

SAT

SUN Week TotalTOTAL to Date

0
0
1.25
0
0
0
0
0
0
0
0
0
1.25
2.5

0
0
2
0.5
0
0
0
0
0
0
0
0.75
1.75

SUN Week TotalTOTAL to Date

0.5

0
0
0
2.25
0
0
0
0
0
0
1.25
3.5

0.5

0.5

1.75
2
0
6.58
0
0
0.33
0
1.16
0
6.08

17.9

22.9

Weekly and Cumulative Log of Internsh

Week Ending: 1/31/2016

Name:

DIRECT Activity

MON

TUES

WED

THURS

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

INDIRECT Activity

MON

TUES

WED

THURS

0.5
0.5

0.5

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

0.75

2.5
3.25

FRID

SAT

0
0
0.75
0
0
0
0
0
0
0
0
0
2.5
3.25

8.25

SUN Week TotalTOTAL to Date

0.5

0.08
3.08

0.5
0
0
1.75
0.5
0
1.25
0
0
0
0.58
4.58

6.33

7.83

1.25

0
0
2.75
0.5
0
0
0
0
0
0
0
0.75
4.25

0.5
0.5

1.25

2.25
2
0
8.33
0.5
0
1.58
0
1.16
0
6.66

22.48

30.73

Weekly and Cumulative Log of Internsh

Week Ending:
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

2/7/2016
MON

TUES

3.75

Name:
WED

THURS

0.5
3.75

2.5

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.75
2

1
0.75

2.5
0.5

0.5
3.25

0.52
6.27

8.77

TOTAL HOURS

SUPERVISOR SIGNATURE:

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

4.25

4.25

FRID

SAT

0
0
10
0
0
0
0
0
0
0
0
0.5
0
10.5

0
0
12.75
0.5
0
0
0
0
0
0
0
1.25
4.25

18.75

SUN Week TotalTOTAL to Date

0.5

0.91
3.16

2.25
2
0
5.25
1.25
0
0
0
0
0
1.93
12.68

7.41

23.18

1.75

4.5
4
0
13.58
1.75
0
1.58
0
1.16
0
8.59

35.16

53.91

Weekly and Cumulative Log of Internsh

Week Ending: 2/14/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

INDIRECT Activity
Site Supervision (Individual)
University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

MON

Name:

TUES

WED

THURS

3.75

MON

TUES

WED

THURS

3.75

2
2.75
0.25

0.5
0.75

0.58
3.58

3.25

7.33

3.25

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

2.5

0.75
3.25

FRID

SAT

0
0
6.25
0
0
0
0
0
0
0
0
0.75
0
7

0
0
19
0.5
0
0
0
0
0
0
0
2
4.25

25.75

SUN Week TotalTOTAL to Date

0.5

2.5

0.5
2
0
7.25
2
0
0
0
0
0
0.58
12.33

5.75

19.33

1
1

5
6
0
20.83
3.75
0
1.58
0
1.16
0
9.17

47.49

73.24

Weekly and Cumulative Log of Internsh

Week Ending: 2/21/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

MON
2.25

INDIRECT Activity

MON

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.75

SUPERVISOR SIGNATURE:

WED

THURS

2.5
0.75

0.5
0.75
3.5

TOTAL HOURS

TUES

Name:

0.5
0.25
4

TUES

WED

THURS

0.5
1

0.5
1

0.5

0.5

0.75

0.67
1.92

1.08
4.83

0.5

5.42

8.83

0.5

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

2.25
1

0.25
3.5

FRID

SAT

0
0
7
0
1.75
0
0
0
0
0
0
1
1.25
11

0
0
26
0.5
1.75
0
0
0
0
0
0
3
5.5

36.75

SUN Week TotalTOTAL to Date

0.5

0.33
4.58

1.75
1
0
1
2.5
0
1.25
3.25
0
0
2.08
12.83

8.08

23.83

0.5

3.25

6.75
7
0
21.83
6.25
0
2.83
3.25
1.16
0
11.25

60.32

97.07

Weekly and Cumulative Log of Internsh

Week Ending: 2/28/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

MON

TUES

3.75

Name:
WED
3.75
1

1.5
5.25

0.5
5.25

INDIRECT Activity

MON

TUES

WED

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.5

TOTAL HOURS

SUPERVISOR SIGNATURE:

THURS

THURS

0.5
1.5
0.75

0.75
1

0.5

0.92
3.17

0.83
4.08

8.42

9.33

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

3.75
0.5

0.5
4.75

FRID

SAT

0
0
11.25
0
1.5
0
0
0
0
0
0
2
0.5
15.25

52

SUN Week TotalTOTAL to Date

0.25

0.75
2.75

1.25
1.5
0
0.75
0.75
0
0.75
3.5
0
0
2.5
11

7.5

26.25

0.75

0
0
37.25
0.5
3.25
0
0
0
0
0
0
5
6

8
8.5
0
22.58
7
0
3.58
6.75
1.16
0
13.75

71.32

123.32

Weekly and Cumulative Log of Internsh

Week Ending:
DIRECT Activity

3/6/2016
MON

TUES

Name:
WED

THURS

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

0.5
0.75
3.75

4.33

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.75

1
2.5

1.58
6.08

1.42
3.17

9.83

7.5

TOTAL HOURS

SUPERVISOR SIGNATURE:

2.5

2.58
1.25

0.5

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

4.75

4.75

FRID

SAT

0
0
9.83
0
1.25
0
0
0
0
0
0
1
0.75
12.83

0
0
47.08
0.5
4.5
0
0
0
0
0
0
6
6.75

64.83

SUN Week TotalTOTAL to Date

1.5

1.5

2.5

1.25
4.75

2.5

2.5

1.75
0
0
1
6.5
0
0
5.5
0
0
4.25
19

9.5

2.5

2.5

31.83

9.75
8.5
0
23.58
13.5
0
3.58
12.25
1.16
0
18

90.32

155.15

Weekly and Cumulative Log of Internsh

Week Ending: 3/13/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

Name:

MON

TUES

WED

2.75

3.75

4.5

THURS

1.5

0.75

4.25

4.5

5.5

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.25

1.75

0.25

2
0.75

3.5

1.33
5.08

0.5
4.5

1
5.75

9.33

11.25

TOTAL HOURS

SUPERVISOR SIGNATURE:

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

4.58
0.5

5.08

FRID

SAT

0
0
15.58
0
1.5
0
0
0
0
0
0
2.25
0
19.33

0
0
62.66
0.5
6
0
0
0
0
0
0
8.25
6.75

84.16

SUN Week TotalTOTAL to Date

0.5

1.51
4.67

2.75
0
0
0
2.66
0
0
14.5
0.75
0
4.34
25

9.75

44.33

0.66

12.5
8.5
0
23.58
16.16
0
3.58
26.75
1.91
0
22.34

115.32

199.48

Weekly and Cumulative Log of Internsh

Week Ending: 3/20/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

INDIRECT Activity
Site Supervision (Individual)
University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

MON

TUES

Name:
WED

THURS

1.5
3
1.5

1.5

4.5

MON

TUES

WED

THURS

0.75
2

1.5

0.75

1.5

1.08
4.58

4.5

9.08

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

1.58
3.5

0.75
5.83

FRID

SAT

0
0
3.08
0
6.5
1.5
0
0
0
0
0
0.75
0
11.83

0
0
65.74
0.5
12.5
1.5
0
0
0
0
0
9
6.75

95.99

SUN Week TotalTOTAL to Date

0.5

0.59
1.59

1.25
2
0
0
2.75
0
0
1.5
0
0
1.67
9.17

7.42

21

0.5

13.75
10.5
0
23.58
18.91
0
3.58
28.25
1.91
0
24.01

124.49

220.48

Weekly and Cumulative Log of Internsh

Week Ending: 3/27/2016
DIRECT Activity

MON

TUES

Name:
WED

THURS

1.25

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

2.5

INDIRECT Activity

MON

TUES

WED

THURS

0.75

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

3.5

0.5
1.25

0.5
0.5
0.5

0.67
2.67

7.67

0.65
1.9

4.4

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

FRID

SAT

SUN Week TotalTOTAL to Date

0
0
2.25
0
3.5
0
0
0
0
0
0.5
1.25
0
7.5

0
0
67.99
0.5
16
1.5
0
0
0
0
0.5
10.25
6.75

103.49

SUN Week TotalTOTAL to Date

2.5

1.75
0
0
0
3
0
0.5
0.5
0
0
1.32
7.07

2.5

14.57

2.5

15.5
10.5
0
23.58
21.91
0
4.08
28.75
1.91
0
25.33

131.56

235.05

Weekly and Cumulative Log of Internsh

Week Ending:
DIRECT Activity

4/3/2016
MON

TUES

Name:
WED

THURS

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

4.17

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

3.17
1

0.75
2
2.25
0.5

5.5

9.67

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

4.33
0.5

0.17
5

FRID

SAT

0
0
7.5
0
1.5
0
0
0
0
0
0
0.17
0
9.17

112.66

SUN Week TotalTOTAL to Date

1.75

1.5

0.5

3.5

0.5

0.5

2.5
2
0
3
0.5
0
0
3
0
0
0
11

8.5

0.5

0.5

20.17

0.25

0
0
75.49
0.5
17.5
1.5
0
0
0
0
0.5
10.42
6.75

0.5

18
12.5
0
26.58
22.41
0
4.08
31.75
1.91
0
25.33

142.56

255.22

Weekly and Cumulative Log of Internsh

Week Ending: 4/10/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

MON

TUES

Name:
WED

4.5

4.35

0.75

0.25

THURS

5.25

4.6

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.25

TOTAL HOURS

SUPERVISOR SIGNATURE:

0.5

1.5
0.75
0.25
1

0.75
2.75

0.65
2.9

7.5

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

3.42
0.5

0.75
4.67

FRID

SAT

0
0
12.27
0
0.5
0
0
0
0
0
0
1.75
0
14.52

0
0
87.76
0.5
18
1.5
0
0
0
0
0.5
12.17
6.75

127.18

SUN Week TotalTOTAL to Date

1.25

0.33
2.83

4.5

2
0
0
2.75
1.25
0
0.25
6
0
0
1.73
13.98

7.5

4.5

28.5

1.25
0.5

20
12.5
0
29.33
23.66
0
4.33
37.75
1.91
0
27.06

156.54

283.72

Weekly and Cumulative Log of Internsh

Week Ending: 4/17/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

MON

TUES

Name:
WED

THURS

0.75

4.75

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.75

TOTAL HOURS

SUPERVISOR SIGNATURE:

0.5
1.5

0.25

3.5
0.5

0.5

1.42
2.92

7.67

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

4.08
2

0.25

6.33

FRID

SAT

0
0
10.08
0
2
0
0
0
0
0
1
0
0
13.08

0
0
97.84
0.5
20
1.5
0
0
0
0
1.5
12.17
6.75

140.26

SUN Week TotalTOTAL to Date

0.25
1

2.5

0.25
2.17

2.5

1.25
1.5
0
0.92
0
0
3.75
4.5
0
0
1.67
13.59

8.5

2.5

26.67

0.67

21.25
14
0
30.25
23.66
0
8.08
42.25
1.91
0
28.73

170.13

310.39

Weekly and Cumulative Log of Internsh

Week Ending: 4/24/2016
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

MON

TUES

2.5

Name:
WED

THURS

4.5

0.5

4.5

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.5

0.58
2

0.25
3.5

0.75

TOTAL HOURS

SUPERVISOR SIGNATURE:

4.25

0.5
0.75
4.58

7.25

9.08

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

2.33
0.5

2.83

FRID

SAT

0
0
9.33
0
0.5
0
0
0
0
0
0.5
0
0
10.33

0
0
107.17
0.5
20.5
1.5
0
0
0
0
2
12.17
6.75

150.59

SUN Week TotalTOTAL to Date

0.75

0.5
0.25
2.5

1.83
2
0
1.5
4
0
0
0
0
1
1
11.33

5.33

21.66

0.5
0.5

23.08
16
0
31.75
27.66
0
8.08
42.25
1.91
1
29.73

181.46

332.05

Weekly and Cumulative Log of Internsh

Week Ending:
DIRECT Activity
Intake/Initial Interview (ADULT)
Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

5/1/2016
MON

TUES

3.75

Name:
WED

THURS

4.75

0.25

4.75

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

0.75
1.5

1
0.25

1
2
0.92
6.17

TOTAL HOURS 10.17

SUPERVISOR SIGNATURE:

0.5
3.75

8.5

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

SUN Week TotalTOTAL to Date

5.75

0.25

FRID

SAT

0
0
14.25
0
0
0
0
0
0
0
0.5
0
0
14.75

0
0
121.42
0.5
20.5
1.5
0
0
0
0
2.5
12.17
6.75

165.34

SUN Week TotalTOTAL to Date

0.25

1.5

0.75
1

1.5

2
1.5
0
2
3.75
0
0
1
0
2
2.17
14.42

1.5

29.17

25.08
17.5
0
33.75
31.41
0
8.08
43.25
1.91
3
31.9

195.88

361.22

Weekly and Cumulative Log of Internsh

Week Ending:

5/8/2016

Name:

DIRECT Activity

MON

TUES

WED

THURS

Intake/Initial Interview (ADULT)

Intake/Initial Interview (CHILD)
Individual Counseling (CHILD)
Individual Counseling (ADULT)
Small Group Counseling (CHILD)
Small Group Counseling (ADULT)
PsychoEducation/Guidance (CHILD)
PsychoEducation/Guidance (ADULT)
Assessment (F2F; CHILD)
Assessment (F2F; ADULT)
Check-In Phone Calls with Client or Family
Consultation with Client System
Other
TOTAL DIRECT CONTACT:

INDIRECT Activity

MON

TUES

WED

THURS

Site Supervision (Individual)

University Supervision (Class)
Listening to your tapes or others tapes
Support Activities (e.g., lesson planing)
Documentation (e.g., Tx Planning, Case notes)
Advocacy
Coordination (with others/activities),
Professional Development
Case Related Research
Program Evaluation Activities (Impact Project)
Other
TOTAL INDIRECT CONTACT:

TOTAL HOURS

SUPERVISOR SIGNATURE:

g of Internship Activity
Home

Emily DeWitt
FRID

SAT

FRID

SAT

SUN Week TotalTOTAL to Date

0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
121.42
0.5
20.5
1.5
0
0
0
0
2.5
12.17
6.75

165.34

SUN Week TotalTOTAL to Date

0
0
0
0
0
0
0
0
0
0
0
0

25.08
17.5
0
33.75
31.41
0
8.08
43.25
1.91
3
31.9

195.88

361.22