Section 1 — Identification
Enter the staff member and supervision details for this plan.
Please complete the required fields (RBT & Supervising BCBA).
Section 2 — Individualized Competency Goals
Pick the phase this team member is in, then check the goals you’ll work on together. You can grab a whole area at once with Select all, or just tap the individual skills you want to focus on — there’s no wrong number.
Please select a phase and at least 5 competency goals to continue.
Section 3 — Review, Acknowledge & Sign
Confirm the plan below, then sign to finalize.
Supervisee acknowledgment.
I understand the scope of services I am authorized to deliver, that I will work under the supervision described above, and that I will document and report as directed by my supervisor. I acknowledge receipt of this plan and the opportunity to ask questions.
Signatures
Supervising BCBA / BCBA-D
Countersignature pending
The BCBA countersigns when the approval bundle is processed — you don’t need to wait.
This plan must be in place before the supervisee delivers billable services, and is reviewed and signed off at least every six (6) months or upon any change in role, supervisor, or scope.
Please acknowledge the statement and add your electronic signature (type your name, then pick a style or tick “I adopt”) before finalizing. Your BCBA signs later.
