CA Board of Psychology Agreement for Supervised Professional Experience 2014 free printable template

WWW.psychology.ca.gov. P (916) 574-7720 / F (916) 574-8672. 1625 N. Market Blvd. N-215, Sacramento, CA 95834.

How to fill out supervision agreement form

How to fill out a supervision agreement form:

1. Start by carefully reading the form and understanding all the terms and conditions mentioned.
2. Enter your personal information accurately on the form, including your name, contact details, and any relevant identification numbers.
3. Provide information about your supervisor, including their name, contact details, and professional license or credentials.
4. Clearly state the duration of the supervision agreement, mentioning the start and end dates.
5. Specify the frequency and duration of the supervision sessions, as well as the method of communication (in-person, phone, video call, etc.)
6. Detail any specific goals or objectives for the supervision period, highlighting what you aim to achieve through this supervision.
7. Mention any specific areas of focus or specialization that need to be addressed during the supervision.
8. Indicate the fee or compensation arrangement for the supervision services, including the payment schedule and any applicable cancellation policy.
9. Review the completed form thoroughly, ensuring all the information provided is accurate and complete.
10. Sign and date the form, and if required, have your supervisor also sign and date it.

Who needs a supervision agreement form:

1. Professionals who are undergoing supervised practice or training in their respective fields.
2. Individuals seeking professional support and guidance from a supervisor or mentor.
3. Organizations or institutions that require their employees or members to engage in supervision as part of their development or learning process.

People Also Ask about supervision agreement form

What is Section 1387.2 of the CCR?

(i) Delegated supervisors shall not supervise a trainee who is now or has ever been a psychotherapy client of the supervisor. (j) Delegated supervisors shall not exploit trainees or engage in sexual relationships, or any other sexual contact with trainees.

What should be included in a supervision agreement?

You should also think about your personal learning style, and what works best for you. How frequent will your supervision be? Where will the supervision take place? Who will be supervising you? How will feedback be provided and what are the terms of confidentiality?

What are the requirements for supervision in California Board of Psychology?

THE PRIMARY SUPERVISOR: Must be a licensed psychologist. Shall possess and maintain a valid, active license free of any formal disciplinary action, and will notify the trainee of any disciplinary action that affects his or her ability or qualifications to supervise.

What counts as supervised professional experience in California?

SPE shall include only the time spent by the trainee engaged in psychological activities that directly serve to prepare the trainee for the independent practice of psychology once licensed. SPE shall not include custodial tasks such as filing, transcribing or other clerical duties.

What is the purpose of supervision agreement?

The terms 'supervision contract' or 'supervision agreement' can be used interchangeably to describe the written document which sets out the content of the discussions that have taken place to establish how the supervisor and supervisee will work together.

What is a supervision agreement?

The supervision agreement is the written document that determines how the participants will work together to achieve mutually-set goals. A supervision agreement should include: the purpose and goals of supervision. roles and responsibilities. frequency and duration of supervision sessions.

For pdfFiller’s FAQs

What is supervision agreement form?

A supervision agreement form is a written document that outlines the terms and conditions of a supervisory relationship between two parties. This form is commonly used in various professional fields, such as counseling, social work, psychology, and education. The supervision agreement form typically includes details about the supervisor and supervisee's roles and responsibilities, such as meeting schedules, communication methods, and the duration of the supervision. It also outlines the goals and objectives of the supervision, the methods of feedback and evaluation, and any specific guidelines or requirements that need to be followed. The purpose of a supervision agreement form is to establish a clear and mutual understanding between the supervisor and supervisee about expectations and standards for the supervisory relationship. It helps ensure that both parties are on the same page regarding the nature and scope of the supervision, which can contribute to effective and productive supervision.

How to fill out supervision agreement form?

When filling out a supervision agreement form, follow these steps: 1. Read the form carefully: Make sure you understand the purpose and requirements of the supervision agreement form. Familiarize yourself with any instructions or guidelines provided. 2. Identify the parties: Enter the names and contact information of both the supervisor (the person providing the supervision) and the supervisee (the person receiving the supervision). 3. Define the scope of supervision: Specify the type of supervision being provided. This could be clinical supervision, professional supervision, or any other specific type of supervision relevant to your situation. 4. Determine the duration of the supervision: State the start date and end date for the supervision period. This could be a specific period (e.g., three months) or an ongoing arrangement until further notice. 5. Establish the frequency and duration of supervision sessions: Indicate how often, for how long, and in what format the supervision sessions will take place (e.g., weekly meetings for one hour in person, via video conference, or over the phone). 6. Set goals and objectives: Outline the goals and objectives that will be pursued during the supervision period. These should align with the professional development needs of the supervisee. 7. Define the responsibilities of the supervisor and supervisee: Clearly state the specific duties and responsibilities of both parties. This may include attending scheduled sessions, preparing for meetings, completing assignments, and maintaining confidentiality. 8. Establish the methods of evaluation and feedback: Specify how the supervisor will evaluate the progress and performance of the supervisee. Describe how feedback will be provided and any evaluation criteria that will be used. 9. Include any additional terms and conditions: If there are any additional terms or conditions that need to be addressed, such as termination clauses, confidentiality agreements, or reporting requirements, include them in this section. 10. Sign and date the agreement: Once the form is completed, both the supervisor and the supervisee should sign and date the agreement to indicate their understanding and acceptance of the terms. 11. Keep a copy: Make sure to keep a copy of the signed supervision agreement form for your records. Note: Consult any applicable laws, regulations, or organizational policies regarding supervision agreements in your particular profession or industry. It may be useful to seek legal or professional advice if you have any questions or concerns.

What is the purpose of supervision agreement form?

The purpose of a Supervision Agreement Form is to document the understanding and agreement between two parties regarding a supervisory relationship. Specifically, it is commonly used in professional settings where one individual supervises or mentors another individual, such as in the context of internships, apprenticeships, or clinical supervision. The form outlines the expectations, responsibilities, and rules that both parties must adhere to during the supervisory period. It helps set clear boundaries, define goals and objectives, establish meeting schedules, discuss confidentiality, outline evaluation and feedback processes, and address any potential issues or concerns that may arise during the supervision. By having a written agreement, both parties benefit from having a clear understanding of their roles and responsibilities, which helps to ensure a productive and effective supervisory relationship.

What information must be reported on supervision agreement form?

The specific information that must be reported on a supervision agreement form may vary depending on the context or industry. However, some common elements that are typically included in a supervision agreement form are: 1. Parties involved: Identification of the supervisor and the supervisee (person being supervised). 2. Date and duration: Mention of the agreement start date and the expected or agreed-upon duration of the supervision. 3. Purpose and objectives: Clear statement of the purpose of the supervision and the objectives to be achieved through the process. 4. Roles and responsibilities: Detailed description of the roles and responsibilities of both the supervisor and supervisee during the supervision period. 5. Meeting schedule: Determination of the frequency, duration, and mode of meetings or interactions between the supervisor and supervisee. 6. Confidentiality: Agreement on the confidentiality of the information shared during the supervision process, while also defining any exceptions or requirements for reporting. 7. Evaluation and feedback: Description of the mechanisms for evaluation, feedback, and assessment of the supervisee's progress, performance, or achievements during the supervision. 8. Termination or modification: Procedures and conditions to terminate or modify the supervision agreement, including any required notice period. 9. Signatures: Confirmation of the agreement by both the supervisor and supervisee, typically by obtaining their signatures. Note: The exact content and requirements of a supervision agreement form may vary depending on the specific context, such as clinical supervision in healthcare, professional supervision in education, or a mentorship program in a business setting. It is important to refer to industry-specific guidelines or regulations when creating or completing a supervision agreement form.

What is the penalty for the late filing of supervision agreement form?

The penalty for the late filing of a supervision agreement form can vary depending on the specific jurisdiction and context. It is advisable to consult the relevant laws, regulations, or guidelines pertaining to the filing of supervision agreement forms in your particular area. Additionally, contacting the appropriate supervisory authority or agency can provide more specific information regarding potential penalties or consequences for late filing.

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