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:__________________________________________________________