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Verification of Experience Form and Supervision Agreement Regulation Advisory

Purpose: 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 effective October 1, 2017.

Summary of Changes:

1. Supervision Agreement between the Supervisor and Supervisee

  • 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.
  • 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).
  • Removes the pre-approval requirement for the Supervision Agreement for psychological assistants who are accruing supervised professional experience in a private practice setting.

2. Verification of 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 Verification of Experience (VOE) form(s) to be submitted by the applicant at the time of application for licensure as a psychologist.

Implementation:

Primary Supervisor

  • Provides feedback to the supervisee regularly and assesses his or her performance throughout the supervision period so that the supervisee can provide psychological services that meet expectation.
  • 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 for licensure as a psychologist.
  • Do not mail Verification of Experience forms directly to the Board.
  • If the original Supervision Agreement has been previously submitted to the Board, supervisor can include a copy of the Supervision Agreement and signed original VOE form(s) in the sealed envelope and signed across the seal. Provide the sealed envelope to the supervisee for submission.
  • VOE form(s) received without an application will not be accepted.

Supervisee

  • Submits the sealed envelope(s) that contain the original signed Supervision Agreement and Verification of Experience form(s) to the Board along with the application for licensure as a psychologist.
  • Should not open the sealed envelope(s).

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.