Remote Sup Application — Beauty in Behavior

Remote Supervision Application

Please complete this form for pre-screening purposes. If all looks good, we will reach out to you via email!

Name

First Name

Last Name

Preferred Pronouns

Desired Certification

Have you started your qualifying behavior analytic coursework?

If not yet, when is your program start date?

Your program's website

We will need this to confirm whether it is considered a verified course sequence (VCS).

http://

If applicable, how many fieldwork hours have you already completed?

We will ask for documentation that reflects this.

Are you currently employed and practice behavior analytic duties?

How many hours do you work per week?

Describe your behavior analytic role.

Do you currently work under a BCBA?

This will help determine which fieldwork verification form we will be signing each month.

If yes, how many?

Desired Fieldwork Type

-Supervised Fieldwork: BCBA (2000 hours), BCaBA (1300 hours) -Concentrated Supervised Fieldwork: BCBA (1500 hours), BCaBA (1000 hours) -Not sure? Don't worry, we'll explain it all so you can make the best informed decision for you!

State

This will help determine whether our supervisors will be eligible to supervise you remotely. At this time, we will only be seeing trainees residing in the US.

Timezone

Your Availability

Trainees are expected to dedicate at least 1 hour/week to meet with their supervisor.

Do you have reliable wi-fi?

Any cultural holidays for us to consider

For scheduling purposes

Any ongoing/potential barriers to supervision

Anything else you'd like us to know