12 CORE FUNCTION SUMMARY SHEET

 

 

Student Name:___________________________________________________

 

Practicum I  or II       (please circle)

 

Midterm or Final       (please circle)

 

Total Hours Completed:_____________

 

 

CORE FUNCTION                                                                          TOTAL HOURS

 

Screening                                                                                         _____________

 

Intake                                                                                                 _____________

 

Orientation                                                                                        _____________

 

Assessment                                                                                      _____________

 

Treatment Planning                                                                        _____________

 

Counseling                                                                                       _____________

 

Case Management                                                                          _____________

 

Crisis Intervention                                                                           _____________

 

Client Education                                                                              _____________

 

Referral                                                                                              _____________

 

Report/Record Keeping                                                                  _____________

 

Consultation                                                                                     _____________

 

 

 

Site Supervisor Signature:_________________________________________

 

Date:__________________________________________________________