Form DCA BBS 37A-638, Associate Clinical Social Worker (ASW) Weekly Log of Experience Hours Completed Form Examples and Samples
Find clear, filled-out examples and samples of Form DCA BBS 37A-638, the Associate Clinical Social Worker (ASW) Weekly Log of Experience Hours. Learn how to accurately complete your log for LCSW licensure in California, with detailed breakdowns of psychotherapy, supervision, and advocacy hours.
Form DCA BBS 37A-638: ASW Weekly Log of Experience Hours Example
How this form was filled:
This sample shows a completed ASW weekly log for a full-time associate at a community mental health clinic, totaling 40 hours for the week. It demonstrates a common mix of experience including individual psychotherapy (both in-person and via telehealth), group therapy, client advocacy, and the required hours of direct supervision. All totals are calculated, and the form is properly signed and dated by both the associate and supervisor.
Information used to fill out the document:
- Associate Name: Jane Smith
- ASW Registration Number: ASW 12345
- Supervisor Name: Dr. Emily Jones
- Supervisor License Type & Number: LCSW 67890
- Employment Site Name: Community Wellness Center
- Employment Site Address: 456 Oak Avenue, Sacramento, CA 95814
- Week Ending Date: 01/17/2026
- Individual Psychotherapy Hours: 15
- Group Psychotherapy Hours: 4
- Telehealth Hours (subset of psychotherapy): 5
- Client Centered Advocacy Hours: 2
- Documentation Hours: 8
- Workshop/Training Hours: 2
- Direct Individual Supervision Hours: 1
- Direct Group Supervision Hours: 2
- Total Hours of Experience Claimed: 40
- Associate Signature Date: 01/18/2026
- Supervisor Signature Date: 01/18/2026
What this filled form sample shows:
- Accurate breakdown of hours across categories like psychotherapy, client-centered advocacy, and documentation.
- Inclusion of telehealth hours, a common practice in modern social work.
- Correct calculation for Total Hours of Direct Supervisor Contact (3 hours) and Total Experience Hours Claimed (40 hours).
- Complete and properly formatted associate, supervisor, and employment site information.
- Timely signatures and dates from both the associate and supervisor, verifying the logged hours for the week.
Form specifications and details:
| Use Case: | Full-time Associate Clinical Social Worker at a community clinic. |
| Form Name: | Associate Clinical Social Worker (ASW) Weekly Log of Experience Hours |
| Form Number: | DCA BBS 37A-638 |
| Jurisdiction: | California Board of Behavioral Sciences (BBS) |
Created: February 25, 2026 05:48 PM
