-
-
-
-
-
All written correspondence will be sent to your Sage e-mail.
-
Example: ABA-510-35
-
-
If you will be supervised by more than one person, separate with a comma. Make sure your Sage professor is aware.
-
I understand that this contract is only for the use of The Sage Colleges and does not replace the contract between supervisor and supervisee required by the BACB. My supervisor and I are responsible for executing our own contract to statisfy BACB requirements for the duration of my supervision. *
-
Will you maintain confidentiality in all matters pertaining to clients served by this agency? *
-
Will you comply with agency policies regarding the development of treatment interventions? *
-
Sage supervisors might, in the course of supervision, make suggestions regarding changes in treatment. Will you be responsible for ensuring treatments comply with all rules and regulations of the agency? *
-
Will you consistently demonstrate a positive and professional attitude while working as a representative of Sage and as a guest of your hosting agency? *
-
Will you provide legitimate information pertaining to your hosting agency, a rightful representative of your hosting agency and your BCBA Supervisor on this contract? *
-
I understand that I must alert my practicum course professor to having more than one BCBA Supervisor, or any changes in my BCBA Supervisor. I understand that my Supervisor(s) must have completed the contract or my experience hours may not be counted. *
-
Do you understand that your on-site or distance BCBA Supervisor should provide you with a signed copy of the BACB Fieldwork and Practicum Experience Supervision Form for each supervision experience? *
-
Do you understand that it is the student’s responsibility to maintain a copy of each BACB Fieldwork and Practicum Experience Supervision Form in the event that the Behavior Analysis Certification Board requests these documents? *
-
Do you understand that you will receive a grade in this practicum only after you, a representative from your hosting agency and your BCBA Supervisor complete and submit the necessary contracts? *
Please note: It is necessary for all parties to complete a new contract each semester.
-
Do you understand that you will receive a grade in this practicum only after a rightful representative of your hosting agency visits: https://www.sage.edu/academics/esteves-school-of-education/applied-behavior-analysis-programs/applied-behavior-analysis-practicum-agency-forms/ to verify that you have completed at least 250 on-site practicum hours? *
Sage reserves the right to verify authenticity of all submissions by contacting the agency representative.
-
Do you understand that you will receive a grade in this practicum only after your contracted BCBA Supervisor visits: https://www.sage.edu/academics/esteves-school-of-education/applied-behavior-analysis-programs/applied-behavior-analysis-practicum-forms/ to verify that you have completed 19 supervision hours? *
A supervisory period is one (1) week. You should receive 1-2 hours of supervision per week. Sage reserves the right to verify authenticity of all submissions by contacting your BCBA Supervisor.
-
I understand that my BCBA Supervisor cannot be my subordinate or relative. *
-
I understand that I cannot be related to any of the clients or the clients’ primary caretaker. *
-
I understand that I am responsible for abiding by all rules and regulations set forth by the BACB, including the BACB Guidelines for responsible Conduct, and I am also responsible for recognizing and complying with any changes they may implement. *
-
I understand that I am responsible for meeting all BACB requirements for supervision. *
-
I have completed the BACB online training module, which can be found here: http://bacb.com/index.php?page=100872 .
-
I understand that I have the right to terminate my relationship with the hosting agency or my BCBA Supervisor at any time by providing them with my wishes in writing. I also understand that I am responsible for dropping or withdrawing from the practicum course in accordance with the rules set forth by The Sage Colleges. (The student may contact Student Services at (518) 244-2201 for assistance.) *
-
I understand that The Sage Colleges has the right to reject a potential hosting agency or BCBA Supervisor because they do not meet the terms set forth by The Sage Colleges, the ABA Program Director or the BACB. *
Students will be notified immediately after receiving contracts from all parties if their practicum placement has not been approved.
-
I understand that it is my responsibility to collect Experience Verification Forms from my BCBA Supervisor at the end of the practicum experience as part of the BCBA exam application process. *
Experience Verification Forms are part of the BCBA exam application and can be found at www.bacb.com.
-
Sage appreciates your understanding of the responsibilities associated with Clinical Practicum in Applied Behavior Analysis. The Center for Applied Behavior Analysis hopes that you to enjoy this significant experience in your education. By signing this document, you attest to the validity and truthfulness of the information supplied in this contract and that the relationships between you (the student), your hosting agency and BCBA Supervisor may proceed in compliance with BACB regulations and the program rules set by The Sage Colleges.
-
I understand this is a legal representation of my signature.
Clear
-