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Supervision Agreement/Verification of Experience Form

Below is a link to the Board's Supervision Agreement and Verification of Experience Form.

Effective October 1, 2017, California Code of Regulations, Title 16 sections 1387 and 1387.1 relating to supervision agreement, the verification of experience, and the responsibilities of the primary supervisor were amended.

Supervision Agreement* Verification of Experience
Specifies that the supervision agreement must outline the structure and sequence of the planned program of supervision that guides supervisee to accomplish the training goals and objectives of the supervised professional experience. Supervised professional experience will not count toward the licensure requirements:
  • for any hours worked prior to the completion of the Supervision Agreement
  • if the supervised professional experience is not consistent with the terms of the Supervision Agreement
  • if the supervisee did not demonstrate an overall performance at or above the expected level of competence
Requires the supervision agreement to identify, in addition to existing requirements, how and when the supervisor will provide periodic assessments and feedback to the supervisee as to whether the supervisee is performing as expected.
Requires the Supervision Agreement to be submitted, along with the signed Verification of Experience form, at the time of application for licensure as a psychologist (unless it has already been provided). Requires the Verification of Experience (VOE) form(s) to be submitted by the applicant at the time of application for licensure as a psychologist.
Removes the pre-approval requirement for the Supervision Agreement for psychological assistants who are accruing supervised professional experience in a private practice setting.

*The purpose of the Supervision Agreement is to ensure that both the supervisor and supervisee understand and have a plan to comply with the laws and regulations related to the accrual of supervised professional experience (SPE).

Upon completion of the supervised professional experience as outlined in the Supervision Agreement, the primary supervisor is required to provide both the signed original Agreement and Verification of Experience form to the supervisee in a sealed envelope, signed across the seal, for submission to the Board by the supervisee along with his or her application.

If any hours of supervised professional experience were accrued prior to January 1, 2005, or if the hours were accrued outside of California, please use the two-page verification of experience form.

The Board has the authority to deny any hours of supervised professional experience if a Supervision Agreement was not properly completed prior to the accrual of hours after January 1, 2005.

Note: Click here for a checklist to assist both the supervisor and supervisee to comply with the regulation changes relating to the Supervision Agreement and Verification of Experience forms. For your convenience, the Supervision Agreement and Verification of Experience forms are provided below to help you meet the requirements pursuant to CCR Section 1387.


Effective October 1, 2017, California Code of Regulations, Title 16, sections 1387 and 1387.1 relating to the supervision agreement, verification of experience, and the responsibilities of the primary supervisor were amended. For more information regarding the specific changes, please click on the following link to review the Verification of Experience Form and Supervision Agreement Regulation Advisory on the Board’s website. http://www.psychology.ca.gov/laws_regs/voe.shtml

A Supervision Agreement (SA) for supervised professional experience (SPE) must be an agreement outlining the goals and objectives of SPE and must be completed and signed prior to the start of the SPE. The SA must meet the requirements set forth in the California Code of Regulations (CCR) section 1387(b)(10). Failure to complete and sign the agreement prior to the start of the experience will result in the Board’s rejection of those hours. For individuals who intend for hours of SPE to count toward meeting the licensing requirements and applying for psychological assistant registrations, the SA must be submitted along with the application.

Updated 10/26/2017