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The form records totals for supervised fieldwork months and hours, separating independent and supervised time within both supervised and concentrated categories, and calculates supervised percentages. It requires supervisor and trainee attestation regarding compliance with BCBA/BCaBA fieldwork requirements, minimum contacts, unrestricted activities, monthly client observations, adherence to BACB ethics, prior supervision training, and signature according to the Acceptable Signatures Policy.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/final-fieldwork-verification-form-individual-supervisor-2022/316441/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/final-fieldwork-verification-form-individual-supervisor-2022/316441.png","ImageObject",300,407,{"name":92,"@type":93},"Jiven","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-20",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",18,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How many forms must be completed for supervisors?","Question",{"text":113,"@type":114},"Complete one form per supervisor. Fill in the entire form for consideration, and incomplete documents are not accepted.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Can the form be completed in a web browser?",{"text":118,"@type":114},"No. Complete it in Adobe Acrobat Reader on your desktop. In a web browser, the dates may not save correctly due to dropdown menus.",{"name":120,"@type":111,"acceptedAnswer":121},"What must the supervisor attest to by signing?",{"text":122,"@type":114},"The supervisor attests that the information on the form is true, the trainee completed fieldwork under supervision in compliance with relevant fieldwork requirements and ethics, the supervisor matches the signed supervision contract, and the 8-hour supervision training was completed before fieldwork started.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},316441,1790500462,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":81,"preview_page_count":4},1099513958607,"https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399","FINAL | FIELDWORK VERIFICATION FORM  \nINDIVIDUAL SUPERVISOR 2022 Fieldwork Requirements  \nInstructions: Please complete one form per supervisor. Complete this form in its entirety for consideration. Incomplete documents will not be accepted.  \nWarning: Forms with missing information will be denied.  \nYou may complete this form in Adobe Acrobat Reader on your desktop, but notin a web browser. This form contains dropdown menus that only work in Adobe Acrobat. Alternatively, If you prefer to print and manually fill out the form, please write your answers over the dropdown options. If you attempt to complete this formin a web browser, the dates will not save correctly.  \nTrainee Name:    \nBACB ID \\#:   ? Start Date:   End Date:    \n(MM/YYYY) (MM/YYYY)  \nThis fieldwork included prorated hours for partial months.  \nState Where Fieldwork Occurred:   Country Where Fieldwork Occurred:    \nFieldwork Type (Select One): Supervised Fieldwork Concentrated Supervised Fieldwork Mixed  \nTotal Months of Supervised Fieldwork Obtained:    \nTotal Months of Concentrated Supervised Fieldwork Obtained:    \nOnly complete the fieldwork type below for the fieldwork typeselection you have made. For example, if you only completed Concentrated Supervised Fieldwork, leave the Supervised Fieldwork Hours section blank.  \nSupervised Fieldwork Hours  \nA. Independent Hours (supervisor not present):   ?  \nB. Supervised Hours (supervisor present):   ?   \nTotal Supervised Fieldwork Hours:  0.00  \n(add A & B)  \nPercent of Hours Supervised:  0.00%  \n(supervised/total)  \nConcentrated Supervised Fieldwork Hours  \nA. Independent Hours (supervisor not present):   ?   \nB. Supervised Hours (supervisor present):   ?   \nTotal Concentrated Supervised Fieldwork Hours:  0.00  \n(add A & B)  \nPercent of Hours Supervised:  0.00%  \n(supervised/total)  \nSupervisor and Trainee Attestation  \nSupervisor Name:   Certification \\# or BACB ID \\#:   Qualification: Choose One  By signing below, we hereby attest that:  \n⊲ Information presented on this Final Fieldwork Verification Form and the corresponding Monthly Fieldwork Verification Forms is true and correct to the best of my knowledge.  \n⊲ The trainee completed the fieldwork under my supervision in compliance with all relevant Fieldwork Requirements (BCBA/BCaBA) including, but not limited to; the minimum number of contacts per month, required amounts of unrestricted activities, required observations each month with clients, and adherence to the BACB’s ethics requirements.  \n⊲ I am the supervisor designated in the signed supervision contract with this trainee.  \n⊲ I completed the 8-hour supervision training prior to the onset of fieldwork.  \nSupervisor Signature:   Date:    \n(MM/DD/YYYY)  \nThis document must be signed in accordance with the Acceptable Signatures Policy.  \nSUPERVISOR AND TRAINEE MUST EACH RETAIN A COPY OF THIS FORM FOR AT LEAST 7 YEARS.  \nVersion 12/2023 | Copyright © 2020, BACB® | All rights reserved. Behavior Analyst Certification Board | Individual Final Fieldwork Verification Form","cbCaigxCYkLRCwGR","https://ap.wps.com/l/cbCaigxCYkLRCwGR","pdf",430574,"English","# Supervisor Fieldwork Requirements\n## Instructions and Completion Rules\n## Trainee and Fieldwork Dates\n## Fieldwork Location and Type\n## Supervised and Concentrated Hours Breakdown\n## Supervisor and Trainee Attestation","[{\"question\":\"How many forms must be completed for supervisors?\",\"answer\":\"Complete one form per supervisor. Fill in the entire form for consideration, and incomplete documents are not accepted.\"},{\"question\":\"Can the form be completed in a web browser?\",\"answer\":\"No. Complete it in Adobe Acrobat Reader on your desktop. In a web browser, the dates may not save correctly due to dropdown menus.\"},{\"question\":\"What must the supervisor attest to by signing?\",\"answer\":\"The supervisor attests that the information on the form is true, the trainee completed fieldwork under supervision in compliance with relevant fieldwork requirements and ethics, the supervisor matches the signed supervision contract, and the 8-hour supervision training was completed before fieldwork started.\"}]","Final Fieldwork Verification Form - Individual Supervisor 2022 | PDF",1789917275]