SP Application Submission

SP Submit ApplicationABE Admin2024-06-03T18:23:28+00:00

To be completed by supervisor with input from candidate. The form is to be submitted by supervisor. Must be submitted by July 15.

Part I: Identifications
Applicant Name:*
First Last
Applicant Email:*
Primary Trainer Name:*
First Last
Primary Trainer Email:*
Part II: Licenses (If Applicable)
If you are licensed or certified as a master’s level mental health professional by a state, complete this section. Please attach a photocopy of your current license.
Primary Trainer's Licenses and Certifications:
Licensed As License #
Dated
MM slash DD slash YYYY
Primary Trainer Verifying License*
- I verify that my license(s) and/or certification(s) to practice in my professional field has never been suspended or revoked due to unethical, unprofessional, or illegal conduct.
Applicant’s Licenses and Certifications:
Licensed As License #
Dated
MM slash DD slash YYYY
Applicant Verifying License*
- I verify that my supervisee's license(s) and/or certification(s) to practice in their professional field has never been suspended or revoked due to unethical, unprofessional, or illegal conduct.
Part III: Supervised Experience
Each applicant must complete at least 300 hours of training and a minimum of 3 supervision sessions.
Date started Psychodrama Training (month/year)*
Number of Hours Completed to Date:*
Number of Hours of Training Completed with Primary Trainer:*
Names of Trainers
Trainer Name Trainer Name Trainer Name Trainer Name
Part IV: Application Attestment:
My primary trainer and I have carefully read and reviewed this SP Application Form and all supporting documents and attest to the accuracy of these documents. I understand it is my responsibility to deliver the SP Application and supporting documents directly to the Board.
Supervisor MUST confirm the following statements:*
- Select All
- I verify that my license(s) and/or certification(s) to practice in my professional field has never been suspended or revoked due to unethical, unprofessional, or illegal conduct.
- I have verified that my supervisee’s license(s) and/or certification(s) to practice in their professional field has never been suspended or revoked due to unethical, unprofessional, or illegal conduct.
- I have reviewed the Supervised Practitioner standards with this applicant.
- This applicant has completed 300 hours of training. At least 100 of those training hours have been with me as the trainer.
- I have reviewed the “Core competencies” and “Practice Recommendations” listed on the ABE website with this candidate.
- I have witnessed this applicant adequately facilitate groups using sociometric principles effectively.
- I have witnessed this applicant adequately direct a full psychodrama or sociodrama session on at least 2 occasions.
- I have engaged in at least 3 supervision sessions with this applicant concurrent to their training experiences. (Please note supervision sessions must have been at least 50 minutes in length and offered the applicant the opportunity to discuss specific psychodrama, sociodrama, or sociometric applications).
- I believe this applicant can assess prudently their own capacities and skills in a professional situation and act ethically.
- I agree to notify the ABE in writing of any changes in the supervisor agreement within 30 days of any changes.
- The candidate and I have reviewed appropriate applications of psychodrama, sociometry, and group psychotherapy within their professional scope of practice.
Part V: Upload Endorsement Form
Please upload your endorsement file below. They must be in .doc, .docx, or .pdf format.
Supervisor Endorsement Form:*
Accepted file types: doc, docx, pdf, Max. file size: 128 MB.
Please attach the endorsement letter confirming your supervision of the candidate.
Submission Date:*
MM slash DD slash YYYY

This website uses cookies and third party services. Ok

Trainer Name	Trainer Name	Trainer Name	Trainer Name

SP Application Submission

Part I: Identifications

Part II: Licenses (If Applicable)

Part III: Supervised Experience

Part IV: Application Attestment:

Part V: Upload Endorsement Form