Get the free Supervision Professional Disclosure Statement

Aimee Perry, M. A, LPC, NCC Outpatient Counselor New Day Counseling Services, LLC 3737 Junction Blvd Raleigh, NC 27603 Office: (919) 7720182 Fax: (919) 7474202 Emergency Cell: (919) 6737809 Website:

How to fill out supervision professional disclosure statement

How to fill out a supervision professional disclosure statement:

1. Begin by providing your personal information, including your name, contact information, and professional credentials. This will help identify who you are and how to reach you.
2. Next, list your qualifications and experience in the field of supervision. This could include any relevant degrees, certifications, or training programs you have completed. It is important to highlight your expertise and demonstrate that you have the necessary knowledge and skills to provide supervision.
3. Specify the scope and nature of your supervisory services. Describe the specific populations or settings you have experience working with, as well as any particular approaches or techniques you utilize in your supervision practice. This will help potential supervisees understand what they can expect from working with you.
4. Include information about your fees and payment policies. Clearly state the rates you charge for supervision services and whether they are per hour or per session. Additionally, outline any policies regarding missed appointments, cancellations, or late payments. This transparency will aid in establishing clear expectations for financial matters.
5. Outline your availability and scheduling options. Indicate your preferred method of communication (e.g., in-person, telephone, video chat) and specify the days and times you are available for supervision sessions. This will assist potential supervisees in determining whether your schedule aligns with their needs.
6. Mention any ethical guidelines or professional organizations you are affiliated with. Provide details about any codes of conduct or ethical principles that you adhere to in your supervision practice. Additionally, mention if you are a member of any professional organizations that hold you accountable to certain standards.

Who needs a supervision professional disclosure statement?

1. Aspiring or current supervisees who are seeking a supervisor in the field of counseling, therapy, or any other profession that requires supervision. This could include individuals who are pursuing licensure or certification in their respective fields.
2. Institutions or organizations that offer supervision services. These could include universities, counseling centers, or agencies that provide supervision to their employees or students.
3. Licensing boards or regulatory bodies that require supervisors to provide a professional disclosure statement as part of their application or renewal process. This ensures that supervisors meet certain criteria and adhere to ethical guidelines.

Overall, anyone who is involved in the supervision process, whether as a supervisee, a supervisor, or an overseeing entity, may need a supervision professional disclosure statement to ensure transparency and accountability in the supervisory relationship.

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What is supervision professional disclosure statement?

Supervision professional disclosure statement is a document that outlines the details of a supervision arrangement between a supervisor and supervisee, including expectations, responsibilities, and boundaries.

Who is required to file supervision professional disclosure statement?

Supervisors and supervisees who are engaged in a supervision relationship are required to file a supervision professional disclosure statement.

How to fill out supervision professional disclosure statement?

To fill out a supervision professional disclosure statement, individuals need to provide information about their professional background, supervision goals, methods, and any relevant policies or agreements.

What is the purpose of supervision professional disclosure statement?

The purpose of supervision professional disclosure statement is to establish clear guidelines, expectations, and boundaries for the supervision relationship, ensuring a safe and effective learning environment.

What information must be reported on supervision professional disclosure statement?

Information such as the supervisor's qualifications, methods of supervision, ethical guidelines, fees, schedules, and contact information must be reported on a supervision professional disclosure statement.