PRACTICUM / INTERNSHIP HOUR ACCUMULATION LOG
The ASE Academy — intern-resources.html
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CACREP minimums: Practicum — 100 hrs total (40 direct)
                 Internship — 600 hrs total (240 direct)
Check your specific program requirements.

Intern: _________________________  Program: ____________________________
Placement Site: _________________  Academic Year: _______________________
Required Total Hours: ___________  Required Direct Hours: ________________

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MONTHLY SUMMARY

Month         Direct Hrs   Indirect Hrs   Total    Cumul.Direct   Cumul.Total
─────────────────────────────────────────────────────────────────────────────
Aug/Sept     __________   ___________   _______   __________   __________
October      __________   ___________   _______   __________   __________
November     __________   ___________   _______   __________   __________
December     __________   ___________   _______   __________   __________
January      __________   ___________   _______   __________   __________
February     __________   ___________   _______   __________   __________
March        __________   ___________   _______   __________   __________
April        __________   ___________   _______   __________   __________
May          __________   ___________   _______   __________   __________
─────────────────────────────────────────────────────────────────────────────
TOTALS       __________   ___________   _______

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DIRECT HOUR BREAKDOWN (cumulative)

Individual counseling:            _______ hours
Group counseling:                 _______ hours
Classroom guidance:               _______ hours
Crisis intervention:              _______ hours
Assessment/consultation:          _______ hours
──────────────────────────────────────────────
TOTAL DIRECT:                     _______ hours  (min. ___ required)

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SUPERVISION HOUR BREAKDOWN (cumulative)

Individual supervision (site):    _______ hours
Group supervision (site):         _______ hours
Individual supervision (univ.):   _______ hours
Group supervision (univ.):        _______ hours
──────────────────────────────────────────────
TOTAL SUPERVISION:                _______ hours

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SIGNATURES — complete at end of each semester

Intern: _____________________________  Date: ___________
Site Supervisor: _____________________  Date: ___________
University Supervisor: _______________  Date: ___________

Certification: I certify that the hours recorded above are accurate
and reflect actual practicum/internship activities.

Intern signature: ____________________  Date: ___________

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