Instructions
Create two supervision forms you will be able to utilize as a future supervisor. There are various samples of supervision contracts and professional disclosure statements available, and sometimes there is overlap in the components included. Your forms should fit your philosophy and assumptions about supervision, as well as the context (real or anticipated) in which you will provide supervision. Focus on the areas that are applicable to your current or future professional settings.
Professional Disclosure Statement which should include the following:
Name and title
Academic degrees, credentials and licenses
Areas of professional competence
A statement about your experience in providing supervision
An overview of your supervision process and personal supervision model
Ethical guidelines that govern your practice
The purpose of supervision
The duties and responsibilities of the supervisor and supervisee
Modalities and interventions to be employed
Procedures for documenting supervision activities and maintenance of records
Fee arrangements
Method(s) and purposes for evaluation
Terms and projected duration of the contract
Procedures for appropriately informing recipients of supervisees’ services about supervisory relationships and related limits of confidentiality
Guidelines for responding to emergencies
Provisions related to due process and filing complaints. For ACS requirements, please see http://www.cce-org/Downloads/Apps/ACSapp.pdf
Instructions Create two supervision forms you will be able to utilize as a futur
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