ASSESSMENT OF COMPETENCIES:

List the competency # and description____________________________________________________

Workshop or seminar	How I reflect this competency in my work.	Validation	Date
		(Attendance record or written transfer of learning.)
	Supervisor's or Reader's Suggestions for improving or completing competency	Second Validation	Date

_________________________	________
Signature of Participant	Date

_________________________	________
Signature of Supervisor	Date

Explicit instructions for completing this form may be found here.


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