Experience Hour Tracking Form
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1Supervised Independent Fieldwork / Experience Hour Tracking Form
Student Name __________________________________________
Supervision period start date
/ /
to supervision period end date
/ /
(These dates must match the periods on your supervision forms.)
Date
Conduct
Design or
Direct Implement
Oversee
Literature
Other
Total Behavior
Assessment
Monitor
(No more than 50% of
Research
Behavior Analytic
Analytic Activities
total experience hours
can be in the direct
implementation of
behavioral programs.)
Week One
Week Two
Total hours
To qualify under the BCBA standard, you must complete 1500 hours of Supervised Independent Fieldwork in Behavior Analysis. To qualify under the BCaBA
standard, you must complete 1000 hours of Supervised Independent Fieldwork in Behavior Analysis. The start-date and end-date of experience may not be more
than 5 years apart. Please see the Behavior Analyst Certification Board for additional/complete requirements for experience hours and supervision.
Record hours to nearest quarter hour. Example 45 minutes = .75
Supervisor’s name (print) ___________________________________
Student name (print)
__________________________________
Supervisor’s signature __________________________ Date: _______
Student signature _________________________Date: ________
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