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SPCA Professional Disclosure Statement Kathryn (Kate) Allison Thrall, MA Office: 3366016049 Email: theaka13×WSU.edu Dear Client, My name is Kate Thrall, and I would like to thank you for choosing
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How to fill out a supervision professional disclosure statement:

01
Start by accessing the necessary form or template for the supervision professional disclosure statement. This may be available online or through your supervisor or licensing board.
02
Begin by entering your personal information such as your name, contact information, and any relevant license or certification numbers.
03
Next, provide details about your educational background and any relevant degrees or certifications you hold. Include the names of the institutions you attended and the dates of your education.
04
Include information about your professional experience. This can include your previous positions, the organizations you've worked for, and any specialties or areas of expertise you may have.
05
If you have any additional training or continuing education, provide details about these programs. Include the titles of the courses or workshops, the organizations that provided them, and the dates of completion.
06
In the disclosure section, provide information about any potential conflicts of interest that may arise while providing supervision. This can include any personal or financial relationships that could impact your ability to provide unbiased supervision.
07
Consider including information about your theoretical orientation or approach to supervision, as well as any supervision models you follow.
08
Finally, review your completed form for accuracy and completeness before signing and dating it.

Who needs a supervision professional disclosure statement:

01
Individuals seeking licensure or certification in a specific field that requires supervision may need to complete a supervision professional disclosure statement.
02
Licensed professionals who are providing supervision to others may also need to have a disclosure statement on file.
03
Supervisors who are members of professional organizations or are affiliated with specific training programs may be required to complete a disclosure statement as part of their membership or affiliation requirements.
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It is a document that provides information about a professional's background, qualifications, and any relevant disclosures.
Professionals who provide supervision services are required to file the supervision professional disclosure statement.
The statement can be filled out online or through a paper form provided by the appropriate regulatory body.
The purpose is to ensure transparency and to provide clients with relevant information about the supervising professional.
Information such as qualifications, experience, any disciplinary actions, and any conflicts of interest must be reported.
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