5+1 TASK COMPLETION FORM
Intern Name
*
First Name
Last Name
Intern Email Address
example@example.com
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Estimated Program Completion Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Supervisor Name
*
First Name
Last Name
Supervisor Email Address
*
example@member.copp.edu.au
Direct client contact (Inc. Simulated)
Required to complete 500 minimum.
Client related
No minimum required
Total psychological practice hours:
Required to complete 1360 minimum.
Principal Supervision
Required to complete 50 minimum.
Secondary Supervision
No minimum required
Group Supervision
Total Supervision
Required to complete 80 minimum.
Professional Development
Required to complete 60 minimum.
Total Internship Hours
Required to complete 1500 minimum.
Direct Observations (2 assessments and 2 interventions per 6 months)
8 minimum
Rows
Completed
College NPE Preparation Module
National Psychology Exam Passed
Save
Submit
Should be Empty: