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DISCLOSURE STATEMENT 1. Martha Hall, M.A., PCC supervised by Leland Cullen, M.A., LEFT, All Inclusive Counseling, Inc., 1802 Chapel Hills Dr. Ste A, Colorado Springs, CO 80920 2. Martha received a

How to fill out supervision professional disclosure statement

How to fill out supervision professional disclosure statement

1. Step 1: Start by gathering all relevant information such as your personal and professional background, qualifications, and experience.
2. Step 2: Use a professional disclosure template or create your own document that includes sections for each required information.
3. Step 3: Begin with providing your name, contact details, and professional title.
4. Step 4: Clearly state your qualifications, educational background, and any certifications or licenses you hold.
5. Step 5: Mention your areas of expertise and specialization in the field of supervision.
6. Step 6: Include information about your experience in providing supervision, including the number of years, settings, and types of clients or supervisees.
7. Step 7: Outline your approach or theoretical orientation to supervision and any specific models or techniques you utilize.
8. Step 8: Clearly describe the fees you charge for supervision services and any payment policies or arrangements.
9. Step 9: Include details about any potential conflicts of interest or dual relationships that may exist.
10. Step 10: Provide information on your availability, including office hours or any limitations on scheduling supervision sessions.
11. Step 11: State your professional obligations and commitment to maintaining confidentiality and ethics.
12. Step 12: Finally, review the completed disclosure statement for accuracy and clarity before distributing it to those requiring the information.

Who needs supervision professional disclosure statement?

1. Supervision professional disclosure statements are necessary for individuals who provide supervision services to other professionals, particularly in fields such as counseling, therapy, social work, or psychology.
2. Professionals who offer supervision to interns, trainees, or individuals seeking licensure in their respective fields must provide a disclosure statement.
3. Organizations or agencies that require their employees or members to engage in supervision may also request supervision professional disclosure statements.
4. In some cases, regulatory boards or licensing authorities may require professionals to submit a disclosure statement as part of the supervision approval or licensing process.

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What is supervision professional disclosure statement?

A supervision professional disclosure statement is a document that outlines the qualifications, practices, and policies of a supervisor regarding their professional relationship with supervisees. It ensures transparency in the supervisory process.

Who is required to file supervision professional disclosure statement?

Typically, licensed professionals who provide supervision to trainees or interns in a clinical or therapeutic setting 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, one must provide detailed information including their professional background, approach to supervision, any fees, confidentiality policies, and emergency contacts, among other relevant details.

What is the purpose of supervision professional disclosure statement?

The purpose of a supervision professional disclosure statement is to inform supervisees about the supervision process and the supervisor's qualifications, thus fostering an open and informed supervisory relationship.

What information must be reported on supervision professional disclosure statement?

The information that must be reported includes the supervisor's qualifications, the nature of the supervision provided, the fee structure, confidentiality expectations, and any specific policies relevant to the supervisory relationship.