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Get SD SLPA Supervision Log

_______________ SLPA Name: SLPA License #: Date  (mm/dd/yy) Activity Hours   Hours  Total  Indirect  Direct  Hours Supervision Supervision SLPA  Initials Total Hours for the month: _________________ Total Direct Supervised Hours for the month: __________________ Total Indirect Supervised Hours for the month: _________________ SLP Supervisor Name: _____________________________ License #: _____________________ SLP Supervisor Signature: _________________.

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