MICRO WEEKLY RECORD OF DIRECT SERVICE HOURS ‘This Record Is For (please check ONE): }gS2Academic [1] $06/PersonavSociat ? DIRECTIONS: Record the amount of time you spent observing and/or working directly with students, parents, and teachers each week. At the end of the semestar, give a copy of this form to your L&C Instructor for inclusion in your departmental file, You should also keep a copy of the signed log for your portfolio. | Individual Students ‘Student ‘Classroom Guidance Parents/Parent Staff Groups opstite| hora 26 mines: {Anon LAId\o} BO rninuke-s | Jove __ Lloladiu| 20, minutes. | 30 pninoies. Liat nace i hoor ih Qp le ‘Lthaor lle 0 pindte! Le Waaytl a ie Wp} el 30 yaiootes | 1 hee lid7 fil} {hove J hour aie Waa lla] Intevu’s Signature Site Mentor's Signature SOTAL DIREC SERVICE HOU} Gime rounded to t 6 Ue SU vate 12|7) Mo pate 277 Ley.MICRO RECORD OF WEEKLY SUPERVISION ‘This Reeord Is For (please cheek ONE): Jesorrcademic C1 s06/Persona/Sociat DIRECTIONS: Record the amount of time you spend each week in supervision. At the end of the semester, give a copy of this form to your L&C Supervisor for inclusion in your departmental file, You should also keep a copy of the signed log for your portfolio, Date On-Site Supervision Lewis & Clark ae ai Class Super’ Supervision at Site | \o}5—Uiflb| 12 hours! sl |_Lof.12 30 _minoke! OL 2O_ minute: 6, __| 80 minok cee WU \ hoor : 2 hoor |i }\b __30.minvkes Date 12.17 Site Mentor’s Signature pate_2/ 7/40 — Intern’s SignatureMICRO RECORD FOR ACTIVITIES OTHER THAI N DIRECT SERVICE AND SUPERVISION (cg. tat ation, mee: uteoach, orientation 10 site) ‘This Record Is For (please check ONE): ef sorcadeni (1) so6/rersonatsSocéat DIRECTIONS: Record all other activities on this form, the amount of time and the date of the activity, Al the end of the semester, give a copy of this form to your L&C Insttuetor for inclusion in your departmental file. You should also keep a copy of the signed log for your portfolio, Date ‘Activity Time |_lo}ta oe meeting \.) boul i cer Jie TH a \\Q Yer yneedtin G eb Train D5 Wool M4 | Seyeol C Viale. “weeting \_\veur {yle__| Diack _imerling _™ | wewrs| —A30 | _S\ok —imeching | Wh 7 Prep for ovidance_lestan |. lous Noj.5 | evierkotion lo Site Lhoor |_\1Ja3. food _ chive, sovep 2 eur Ao} Ni Choke EleMey yeading | \ Wor ofld _|recdavve irforrnation(iesearcdh | 2 ax, 6] 20 DS reporting reading heseawell Q hours] Loh a-al7 |Sumamosies /reCechion panes | 5 wars el Research on Kiddo Foy SSP-Berdire 2. hous] ‘TOTAL HOURS: |39.5 Intern’s Signature eh a Date 12.J7] Io Suni vue IZ p Site Mentor’s Signature _DIRECTIONS: At the end of the semester, record the total hours in each sub eategory within Direet, Supervision and Other Hours and then fotal each eategory. Give a copy of this form to your L&C Instructor for inclusion in your departmental file, You should also Ieeep a copy of the ( signed log for your portfolio. FINAL MICRO INTERNSHIP SUMMARY FORM. A ‘This Record Is For (please check ONE): JxlS02/Academic $06/Personal/Social intern Breidtarn, Sill _ site Piversicle, Elemectacy School site Address 030% SE, Biver Wel, Portland, OR 1767 Mentor_Lincla__Furd _ Dates: rom 1O]12/ 2OUo to 1] 7/BOUa MICRO DIRECY SERVICE HOURS Activity, ours, Individual Students 3 Student BO haw Classroom Guidance oi how | Parents/Parent Groups Staff. Aetivit On-site Supervision L&C Micro Internship Class Supervision Supervision at Site ‘Lraining/In-serviee (ite) Mectings Other (In-service reading) Tutern’s Signature: Date 12.) 7] Mo Date_ 2 /7/ lip L & C Instructor's Signature Sr Ss Date_\- 9 S-|7J (6 J Site Mentor’s Signature