Supervision Contract For Independent Supervision

Supervision Contract For Independent Supervision - Bcba Page 3

limited to, any medical or clinical information, in whatever form. Supervisor and supervisee shall

be jointly responsible for ensuring that clients have consented to the observation of service

delivery and sharing of confidential client information.

TERM AND TERMINATION

Term. This agreement shall be effective on ________ and shall remain in effect until either party

terminates this agreement by 14 days advance written notice to the other of the intention to

terminate.

Supervisee Name ______________________ Phone number __________________________

Addresss _____________________________________________________________________

E-mail Address ________________________________________________________________

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The responsibilities described in this document will be carried out in accordance with the

BACB’s Guidelines for Responsible Conduct for Behavior Analysts and Professional

Disciplinary and Ethical Standards.

All parties agree to the stipulations herein:

Supervisee Name (printed): ____________________

Supervisee signature: _____________________________

Date: _______

Supervisor Name & Credentials (printed): ____________________

Supervisor signature: _____________________________

Date: __________

Supervision Contract For Independent Supervision - Bcba Page 3