BCaBA Annual Supervision Verification Form PDF Details

Who Must Submit This Form

The BCaBA Annual Supervision Verification Form is required by the Behavior Analyst Certification Board® (BACB®) for all Board Certified Assistant Behavior Analysts™ (BCaBAs) completing their annual renewal or recertification. It must be submitted once per year alongside the renewal application to confirm that the BCaBA received all required supervision from a qualified Board Certified Behavior Analyst® (BCBA®).

What the Form Documents

This form captures a full record of supervision provided during the certification period. It requires the total number of supervision hours received, including in-person hours spent directly observing service delivery. The supervising BCBA must attest that all sessions followed BACB professional and ethical standards and that the BCaBA participated in structured feedback and review sessions throughout the year.

Supervision Standards and Requirements

Supervision documented on this form must meet the minimum standards set by the BACB. Sessions must include regular in-person observation of the BCaBA providing behavior analysis services, along with systematic performance feedback and review. The supervising BCBA signs the form and certifies the accuracy of all documented hours and interactions. Inaccurate or false information on this form may result in sanctions against the BCaBA's certification status.

Multiple Supervisors

When a BCaBA received supervision from more than one BCBA during the certification year, a separate BCaBA Annual Supervision Verification Form must be completed for each supervising BCBA. All completed forms are submitted together with the renewal application. Related forms available on FormsPal include the Supervision Agreement and the Blank Supervision Hours Form for tracking hours throughout the year.

QuestionAnswer
Form NameBCaBA Annual Supervision Verification Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmonthly verification form supervision bacb, bacba supervison varifcation form, bcaba supervision verification form, experency verification form bcaba supervicion october 2018

How to Edit Bcaba Annual Supervision Verification Form Online for Free

What You Need Before You Begin

Before filling out the BCaBA Annual Supervision Verification Form, gather the following information:

  • Your full legal name and BACB ID number
  • Your supervising BCBA's full name and certificate number
  • Total supervision hours received during the certification period
  • A breakdown of session types: in-person observation, group supervision, and review sessions
  • The start and end dates of the supervision period covered by this form

Step-by-Step Instructions for the BCaBA Annual Supervision Verification Form

  1. Download the form using the button above and open it in FormsPal's online PDF editor or save it to your device.
  2. Complete the BCaBA section by entering your full name, BACB ID, and contact information.
  3. Enter supervisor information by filling in your supervising BCBA's name, BCBA certificate number, and contact details.
  4. Record supervision hours by entering the total number of supervision hours received, including the breakdown by type of session as required by BACB guidelines.
  5. Document the supervision period by listing the start and end dates of the annual period covered by this form.
  6. Review for accuracy before signing. Both the BCaBA and the supervising BCBA must sign and date the completed form.
  7. Submit to the BACB along with your annual renewal application. If you had multiple supervisors, include a separate completed form for each one.

When to Submit the BCaBA Annual Supervision Verification Form

This form must be submitted at the time of your annual BACB certification renewal. Submitting it late or omitting it from the renewal package will delay processing. BCaBAs who worked with more than one BCBA during the year must submit one completed form per supervisor. Keep a copy of each signed form for your personal records.

Related Supervision Forms

You may need these related forms during the supervision and renewal process:

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