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Practicum/Internship students should complete this form at the end of the Practicum/Internship experience. After reviewing with your Site Supervisor, the Practicum/Internship faculty at CAU, a copy will be sent to the Practicum/Internship Site Supervisor.

Please check the response that described your supervision experience most accurately.

* 1. Student's Name

* 2. Site Supervisor's Name

* 3. Practicum/Internship Semester

* 4. Placement Site

* 5. University Supervisor

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