History Whitney M. Young, Jr., School of Social Work 0


BSW STATISTICAL REPORT FORM



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BSW STATISTICAL REPORT FORM


Student:

Agency:

Reporting Months:



Address:

Faculty field liaison:

Agency Field Supervisor

Monthly Caseload




CLIENTS


# Cases

# Intakes

# Sessions

# Cancellations

Males/Females




Adults (20+)













/




Adolescents (13-19)













/




Child (0-12)













/




Family













/




Group













/




Community













/



Total














/




# of hours received in individual/group supervision for the term: ___________
Number of presentations you performed: ___________
Race and ethnicity of clients (indicate number for each):
African Americans ____ Hispanic _____

Asian Americans ____ Native American _____


Caucasian ____ Other _____

MEETINGS ATTENDED


# HOURS




Staff







Community







Administrative







Rounds







Case conferences







Other:







BSW TIME SHEETS AND EDUCATIONAL LEARNING PLAN

Whitney M. Young, Jr., School of Social Work

Clark Atlanta University



BSW TIME SHEET – Fall Semester

From -To

Mon

Tues

Wed

Thurs

Fri

Sat/Sun

Total

Initials















































































































































































































































































































































































Grand Total _______________
BSW STUDENTS: 16 hours per week for a minimum total of 192 hours

The original time sheet must be initialed each week during supervision by the Agency Field Supervisor. Students will complete one time sheet per semester. The time sheet shall be initialed by the field agency supervisor each week during supervision. At the end of each semester, the initialed and signed time sheet is submitted to the School with total number of clock hours along with the student’s final evaluation to the field seminar instructor.



Student/Date ________________________________ Supervisor/Date _____________________________




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