Student Name:
E-mail Address:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
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Time Log
List the Objective(s)
Evaluate biological basis of psychotherapy treatments.
Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatment
List the Objective(s) met and Briefly describe the activities you completed during each time period for 4 patients. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.

Time Log
Dates Times
Total Hours for This
Time Frame
Activities/Comments Learning Objective(s) Addressed


Total Hours Completed:

Journal Entries

  • Include references immediately following the content.
  • Use APA style for your journal entry and references.