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Chicago State UniversityMaster of Social Work ProgramWeekly Supervision LogStudent _____________________________________________________________Email Address _______________________________________________________MSW Providing Supervision ____________________________________________Email Address _______________________________________________________Faculty Field Liaison __________________________________________________Please Check Foundation Advanced Direct PracticeAdvanced Program Planning and AdministrationAdvanced School Social WorkPost MSW PELFall SemesterSpring SemesterYear 20 ____Students are expected to receive supervision at least 1x each week, for one hour. Please indicate the day, date and length of time for supervision received in the space provided below.SupervisionDayMondayTuesdayWednesdayThursdayFriday SaturdaySundayDateLengthSupervision Agenda Items (List 3. Can be derived from student, field instructor or both.)Reflection of Tasks and Activities that support the development of Competencies.Specifying the Competencies and discuss how the competencies and practice behaviors identified were addressed in practice. Please refer to the student learning plan. You can and are encouraged to discuss more than one in your petency or competencies AddressedReflectionSupervisor’s Feed Back to Student regarding Reflection of Tasks and Activities that support the development of Competencies.Student is to annotate in their own words._______________________________________ ___________________________________________Student Signature Date Supervisor Signature DateOptional: Student or Supervisor areas of progress, acknowledgements, growth, concerns, suggestions for growth or issues: ................
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