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Supervision Disclosure Statement of Becca McConnell, MA, PCs
McConnell.LPC×gmail.com
Office Cell: 512.608.2563
I am excited to be your clinical supervisor during your LPC Internship. The following
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How to fill out supervision disclosure bstatementb of

How to fill out supervision disclosure statement:
01
Start by providing your personal information such as your name, address, and contact details. This information is important for identification purposes.
02
Indicate the name and contact information of your supervisor or the person who is overseeing your work. This includes their full name, job title, and organization.
03
Specify the nature of your supervision. Explain the purpose and objectives of the supervision, whether it is for professional development, training, or any other specific reasons.
04
Include the timeframe of the supervision. State the start and end dates of the supervision period, or provide an estimated duration if the exact dates are not yet determined.
05
Describe the supervision activities that will take place. This can include regular meetings, progress reviews, assessments, training sessions, or any other relevant activities that will be part of the supervision process.
06
Outline the roles and responsibilities of both the supervisor and the supervisee. Clearly explain what is expected from each party during the supervision period, including any reporting or documentation requirements.
07
Include any specific guidelines or protocols that need to be followed during the supervision. This could involve confidentiality agreements, ethical guidelines, or any other relevant policies that should be adhered to.
08
Indicate how the supervision will be evaluated or assessed. This could involve self-assessment, supervisor feedback, or any other means of measuring progress and effectiveness.
09
Finally, both the supervisor and the supervisee should sign and date the disclosure statement to indicate their understanding and agreement with its contents.
Who needs supervision disclosure statement:
01
Students undergoing professional or clinical supervision as part of their academic or training programs. This could be individuals pursuing degrees in fields such as counseling, social work, psychology, or teaching.
02
Employees who are being supervised as part of their job performance evaluation. This can include new employees, those undergoing a skills development program, or individuals seeking professional advancement within an organization.
03
Individuals seeking mentorship or guidance from experienced professionals. This could be entrepreneurs, artists, or individuals in any field who are looking for guidance and support from a mentor.
It is important to note that the need for a supervision disclosure statement may vary depending on the specific requirements of an institution, organization, or field of study. It is advisable to consult the relevant guidelines or seek clarification from the appropriate authorities to determine if a supervision disclosure statement is necessary in your particular situation.
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What is supervision disclosure statement of?
Supervision disclosure statement is a document that discloses information about a firm's supervision policies and procedures.
Who is required to file supervision disclosure statement of?
Firms regulated by a governing body are required to file supervision disclosure statement.
How to fill out supervision disclosure statement of?
Supervision disclosure statement should be filled out by providing detailed information about the firm's supervision policies and procedures.
What is the purpose of supervision disclosure statement of?
The purpose of supervision disclosure statement is to ensure transparency and compliance with regulations regarding supervision practices.
What information must be reported on supervision disclosure statement of?
Information such as the firm's supervisory structure, processes for monitoring compliance, and training programs for employees must be reported on supervision disclosure statement.
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