Documenting Supervised Work Experience

Peer Support Specialists are required to document their supervised work experience at least monthly during program enrollment.

Name

First Name

Last Name

Phone

(###)

###

####

Please indicate your Apostles of Life program site and QPC.

PSS need to indicate their Apostles of Life program site and QPC.

What Supervised Experience are you documenting today?

Direct Hours with Peers

QPC Supervision

Prayer/Reflection Journal

Indirect PSS Work Hours (Training and other tasks)

Please indicate the Total Hours Completion Date for Today's Submission

This Field is where the PSS will indicate the Total Hours completed are through this date.

YYYY

Number of Direct Hours with Peers

Enter the Number of Direct Hours completed with Peers as part of the Apostles of Life program to date.

Number of Hours of QPC Supervision

Enter the Number of Hours of QPC Supervision completed with QPC as part of the Apostles of Life program to date.

Number of Hours of Prayer/Reflection Journal

Enter the Number of Hours of Prayer/Reflection Journal completed as part of the Apostles of Life program to date

Number of Indirect PSS Work Hours

Enter the Number of Hours of Indirect PSS Work Hours completed as part of the Apostles of Life program to date

Please indicate any additional hours or information to support the hours documented today as/are accurate and authentic.

PSS are required to attest that their supervised work experience documented to date is accurate and genuine.

Attestation: Do you attest that the hours you reported today are accurate and genuine?

PSS need to attest to the authenticity of their supervised work experience.