1
List 3 Activities you completed this week:
Field Supervisor Signature______
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
2
List 3 Activities you completed this week:
Field Supervisor Signature______
BSW FIELD PLACEMENT TIME SHEET: Bloomsburg University
Student______Field Placement Site:______
Field Supervisor______Field Liaison:______
Semester (pick one) Fall_____ Spring______Year______
Student: / Agency: / Supervisor:Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
3
List 3 Activities you completed this week:
Field Supervisor Signature______
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
4
List 3 Activities you completed this week:
Field Supervisor Signature______
Student: / Agency: / Supervisor:
Student: / Agency: / Supervisor:
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
5
List 3 Activities you completed this week:
Field Supervisor Signature______
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
6
List 3 Activities you completed this week:
Field Supervisor Signature______
Student: / Agency: / Supervisor:
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
7
List 3 Activities you completed this week:
Field Supervisor Signature______
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
8
List 3 Activities you completed this week:
Field Supervisor Signature______
Student: / Agency: / Supervisor:
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
9
List 3 Activities you completed this week:
Field Supervisor Signature______
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total to Date
10
List 3 Activities you completed this week:
Field Supervisor Signature______
Student: / Agency: / Supervisor:
Student / Agency / Supervisor
Week / Dates / Monday / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total Hours to Date
11
List three activities you completed this week:
Supervisor Signature______
Student / Agency / Supervisor
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total Hours to date
12
List three activities you completed this week:
Supervisor Signature______
Student / Agency / Supervisor
Week / Dates / Monday / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total Hours to Date
13
List three activities you completed this week:
Supervisor Signature______
Student / Agency / Supervisor
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total Hours to date
14
List three activities you completed this week:
Supervisor Signature______
Student / Agency / Supervisor
Week / Dates / Monday / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total Hours to Date
15
List three activities you completed this week:
Supervisor Signature______
Student / Agency / Supervisor
Week / Dates / Mon / Tue / Wed / Thurs / Friday / Sat/Sun / Total Hours / Total Hours to date
16
List three activities you completed this week:
Supervisor Signature______
Student Signature______
Field Supervisor/Task Supervisor Signature______
**Students are required to submit a completed time sheet at the end of the term. The signature of the field instructor and the student reflects that the student has met the required hours for the term. If the student needs to clock more hours after the end of the term to achieve the minimum hours required, please note this in the below comments section. Falsification of hours will result in disciplinary action and potential removal from your field internship.
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