DocDocuSign Envelope ID: 0D9D6DF8-F286-4F8F-A5CF-3B3AC48B66D5843DDC0E
80
25
B1B BFFCFAE79BCD
Master of Science in Counseling and Human Services
COUNSELING FIELD PLACEMENT LOG
Current Month Date Range:
From 11/16/2022
Practicum / Internship Site:
CMET
Joyce A. Marte
Adelle Flores, LMHC
Student Name & Signature:
Supervisor Name & Signature:
To 12/08/2022
Week 1
Week 2
Week 3
8 Hours
4 Hours
9 Hours
Hours
1 Hours
1 Hour
Hours
2 Hours
1 Hours
1 Hour
Hours
10 Hours
6 Hours
11 Hours
7 Hours
Hours
Week 1
Week 2
Week 3
Week 4
TOTAL
*Individual Supervision (Required 60 min/week)
1 Hour
1 Hour
1 Hour
Hour
Hours
*Group Supervision (Required 90 min/week) (OP
Meeting)
1 Hour
1 Hour
1 Hour
Hour
Hours
Observation (1.1 supervision, and training)
1 Hours
1 Hour
1 Hour
Hour
Hours
Phone/Email
1 Hour
1 Hour
1 Hour
DIRECT SERVICE HOURS
Individual Counseling (Sessions)
Week 4
TOTAL
Family/Couples Counseling
Group Counseling
Diagnostic Interviewing (SASSI, Post- op, and AAIP
questionnaire)
Testing & Assessment (SASSI Scoring, Post-op
scoring, AAPI scoring)
Co-therapy
Career Counseling
TOTAL DIRECT HOURS (per week)
INDIRECT SERVICE HOURS
Hours
Referrals/Case Management
Report Writing/Clinical Notes
Case Consultation
Staff Meetings
Professional Development
Other Indirect Service Activities (specify)
Hour
8 Hours, 8 Hours
30 min
1 Hour
3 Hour,
30 min
Hours,
min
Hours,
min
Hours
TOTAL INDIRECT HOURS (per week)
12 Hours 13 Hours 7 Hours,
30 min
Hours,
min
Hours,
min
CUMULATIVE HOURS
ID: 0D9D6DF8-F286-4F8F-A5CFDocuSign Envelope
DIRECT
HOURS (current month) 3BAC48B66D 5 DIRECT HOURS (total obtained in course to date)
INDIRECT HOURS (current month)
Hours
202
Hours
Hours, INDIRECT HOURS (total obtained in course to date)
min
202 Hours
& 40 min
DocuSign Envelope ID: 843DDC0E-F806-425F-AB1B-BFFCFAE79BCD
TOTAL HOURS (current month)
78 Hours
& 30 min
TOTAL HOURS (total obtained in course to date)
404
Hours, 40
min
Summary of Work Performed / Learning Opportunities
Describe activities, population served, and learning goals addressed
Include at least 3 scholarly references to connect theory and practice
1-2 pages in length
WEEK 1=18 Hours, 30 min+ (2*) + (4 SASSIý2 Hours) =22 Hours, 30 min
8 clients seen, Outpatient group supervision, 1.1 Supervision, Internship meeting, Sessions done for clients
pertain of the following: 4 Individual Counseling, 2 Anger Management sessions, 1 BatteràIntervention
session, 1 supervised visit, also spent time documenting notes for each session, and completed scoring 4
SASSIî
11/16/22 8:00 am- 6:30pm. 9 hours, 30 min
11/17/22 8:00am- 6:00pm. 9 hours
WEEK 2= 17 Hours + (2*) = 19 hours
4 clients seen, Outpatient group supervision, 1.1 Supervision, Internship meeting, Sessions done for clients
pertain of the following: 1 individual session, 2 Anger management sessions, and 1 supervised visit. Also
spent time documenting notes for each session.
11/22/22 9:30am-6:00pm 8 Hours, 30 min
11/23/22 (*8 Hours, 30 min)
WEEK 3= 16 Hours, 30 minutes + (2*) = 18 hours, 30 min
9 clients seen, 1.1 supervision, Internship meeting, OP meeting, Sessions done for clients pertain of the
following: 5 Individual counseling, 1 Parenting session with special needs, 1 Batteràintervention session,
And 2 Anger management sessions. Also spent time documenting notes for each session.
11/30/22 8:00am-5:30pm 8 Hours, 30 min
12/01/22 8:00am-5:00pm. 8 Hours
Week 4 = ???

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