INFORMATIONAL MATERIALS

Applicant Activities (21 NCAC 54 .2007)

Licensed Psychologist-Provisional Activities (21 NCAC 54 .2009)

Psychological Associate Activities (21 NCAC 54 .2006)

Supervisor and Supervisee Responsibilities

Maintaining Clear and Accurate Supervisory Records

NEW Supervision Contract 101: What does interior design have to do with supervision?

NEW Supervision Report 101: A supervisor's guide to understanding the Supervision Report Form

NEW Supervision Report 102: A detailed look at the Generic Information & Section 2

FORMS

Supervision Contract Form and Instructions A Supervision Contract Form documents either that supervision is needed, is being received, and why, or that supervision is not required, and why.  All Applicants, Provisionally Licensed Psychologists, and Licensed Psychological Associates are required to have an accurate, up-to-date Supervision Contract Form on file with the Board at all times, regardless of employment setting or activities in which the individual may, or may not, currently be engaged (e.g., unemployed, practicing in-state, practicing out-of-state, working in another field, etc.).  A Supervision Contract Form must be filed within 30 days of a change in, or termination of, the conditions of the existing contract on file with the Board.  Contracts cover current activities.

Supervision Report Form The Supervision Report Form is much like a progress report in that it gives the Board an update on the activities of an Applicant, Provisionally Licensed Psychologist, or Licensed Psychological Associate for a certain period of time.  Reports must be filed within two weeks of a change in, or termination of, the conditions in a Supervision Contract Form already on file with the Board.  Reports cover past activities.  Provisionally licensed psychologists please note: If you believe that you have met the post-doctoral requirements for permanent licensure (1500 post doctoral hours AND a minimum of 1 calendar year - i.e., 12 months of practice), DO NOT have your supervisor complete this form.  A specialized report form will be mailed to your supervisor once your provisional to permanent licensure application materials have been received.  Please click on the link "Provisional to Permanent Licensure" on the sidebar for additional information.

Alternate Supervision Plan and Requirements

Supervision Record Form

    REDUCED SUPERVISION    

Instructions for Reduced Supervision (RS Form#1)

Application for Reduced Supervision (RS Form#2)

Report for Reduced Supervision (RS Form#3)

 

PLEASE NOTE: All forms are now interactive.  You may open forms using Adobe Reader (follow the link on the sidebar to the left for a FREE download of the latest version) and type directly into the text fields.  While the forms are INTERACTIVE (information may be typed directly into text fields) Adobe Reader will not allow data to be saved upon exit of the program. Individuals are strongly advised to print copies before exiting out of forms.  These forms may not be submitted electronically or by fax. If you have any trouble using the new forms, or have any questions, please contact April Everett at the Board office.