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Supervision Disclosure Statement Dr. Colette Dollar hide p. 1 of 3PROFESSIONAL SUPERVISION DISCLOSURE STATEMENT Colette T. Dollar hide, Ed. D., NCC, ACS, PC & PCS (OH) Associate Professor, Counselor

How to fill out professional supervision disclosure statement

How to fill out a professional supervision disclosure statement:

1. Start by including your personal information such as your full name, contact information, and any professional affiliations you have.
2. Next, provide a brief description of your professional experience and qualifications. This should include any relevant licenses or certifications you hold.
3. Disclose any conflicts of interest that may arise during the professional supervision process. This could include any personal or professional relationships that may impact your ability to provide unbiased supervision.
4. Outline your approach to professional supervision. This could include discussing your theoretical orientation, your preferred supervision models, and any specific methodologies or techniques you utilize.
5. Provide information on your experience in providing professional supervision. This can include the number of years you have been providing supervision, your areas of expertise, and any specific populations you have supervised.
6. Include a statement regarding your commitment to maintaining professional boundaries and confidentiality. This is important for establishing trust and ensuring the privacy of any sensitive information that may be shared during supervision.
7. Finally, sign and date the disclosure statement to indicate your understanding and compliance with the information provided.

Who needs a professional supervision disclosure statement?

1. Mental health professionals: This includes therapists, counselors, psychologists, and social workers who provide clinical supervision to interns or other professionals in their field.
2. Healthcare professionals: Doctors, nurses, and other healthcare practitioners who provide supervision to medical students, residents, or other healthcare professionals.
3. Education professionals: School administrators, teachers, and coaches who provide professional supervision to educators or support staff.
4. Human resources professionals: HR managers or professionals who provide supervision to HR staff or other employees within the organization.

In summary, anyone who provides professional supervision to others should have a professional supervision disclosure statement in place. This helps ensure transparency, clarify expectations, and protect the rights and interests of both the supervisor and the supervisee.

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What is professional supervision disclosure statement?

The professional supervision disclosure statement is a document that outlines the details of supervision received by a professional in a particular field.

Who is required to file professional supervision disclosure statement?

Professionals who are required to receive supervision as part of their licensure or certification are required to file the professional supervision disclosure statement.

How to fill out professional supervision disclosure statement?

The professional supervision disclosure statement can be filled out by providing information such as the name of the supervisor, the duration of the supervision, and the areas covered during supervision.

What is the purpose of professional supervision disclosure statement?

The purpose of the professional supervision disclosure statement is to ensure transparency and accountability in the supervision process.

What information must be reported on professional supervision disclosure statement?

The professional supervision disclosure statement must include information such as the name of the supervisor, the duration and frequency of supervision, and the specific areas covered during supervision.