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VISTA - BCBA Supervised Experience
The BACB requires supervision for experience hours worked per week. The amount of supervision required depends on both the type of experience requested and the amount of hours worked. If you are interested in completing your supervised hours at Vista, please complete and submit the following form.
The BCBA Supervised Experience at Vista requires a significant commitment of staff time and resources; therefore each request is carefully reviewed for consideration. You will receive a response within two weeks.
Name:
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First
Last
Email:
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Confirm:
School:
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Program:
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Classes completed:
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Type of experience requested:
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Supervised independent field work
BACB approved university practicum
BACB approved university intensive practicum
Have you completed the online supervision module?
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Yes
No
If yes, please attach certificate of completion:
If no, this module must be completed prior to the initiation of supervision. Please indicate date in which this will be completed:
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Have you had any supervised experience or practicums previously?
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Yes
No
If yes, name and title of supervisor:
If yes, dates of previous experience:
If yes, number of hours:
For which Vista program are you interested in completing your supervised hours?:
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School
Adult Services
Outreach
On what days of the week are you interested in completing your supervised hours? (Please select all responses that apply.):
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (Adult Services)
Sunday (Adult Services)
During what hours of the week are you interested in completing your supervised hours? (Please select all responses that apply.):
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Morning
Afternoon
Evening (Adult Services)
Night (Adult Services)
Do you have any special request(s) or expectation(s)?
Do you have a special interest within the fields of Autism or ABA?
Attach resume:
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Attach brief letter of interest:
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Additional information you would like to provide:
* Required Field
