Assessing supervision needs form

Thanks for considering The Provisional Psychologist Network to support you in your journey towards registration or endorsement. This form has been completed to get the most information from you that will support us determining the best supervisor fit. The more information you give us the better fit we can make.

If you already know which supervisor you would like to work with still fill in the form so we can confirm they have the correct professional experience to support you. The matched supervisor and admin will review this form. This form will remain confidential outside of this purpose. If there is anything you like to share not in written form please contact us on 0447332708.

If you don't have a role yet, don't fill in the form. Just contact us once you know your role, and then we can match you. This is because your supervision match needs to be determined by what you need supervision support with.

PROCESS FOR PRIMARY SUPERVISION

1. You to fill in this brief form
2. The Provisional Psychologist Network will then review our supervisors to match you with the correct fit
3. We will then direct you to the supervisors bio we have chosen to see if you agree to meeting with them for a no fee 15 minute consultation where you can ask questions to determine if it will be a good match
4. You then let us know if you would like to go forward with this fit, we can offer another supervisor if the match was not suitable
5. We then send you a welcome pack and supervision contract and you book in a session to complete paperwork

PROCESS FOR SECONDARY SUPERVISION

1. You to fill in this brief form
2. The Provisional Psychologist Network will then review our supervisors to match you with the correct fit
3. We will then direct you to the supervisors bio we have chosen to see if you agree
4. You then let us know if you would like to go forward with this fit
5. You can then send any required paperwork to be signed, or we can send you a signed secondary letter template to add our supervisor to your internship plan
6. We then send you a welcome pack and supervision contract
7. Book sessions as needed

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Location*

Role & Responsibilities (which age groups, across the lifespan etc):*

Are you going to be working in positive behaviour support (NDIS)?*

Hours contracted to work per week?*

Internship pathway you are seeking to complete?*

If registrar, which endorsement?

What supervision support are you requiring? Secondary? Primary? Registered? Group Supervision? Case Report Review? *

Have you already commenced an internship program? If so how many hours and which tasks have you completed? *

Availability for supervision? Add any constraints you have*

Previous work experience and qualifications*

Therapies trained in*

What are you looking for in a supervisor?*

Any specific interests?

Our supervisors only provide sessions online via zoom or via telephone. Is this ok with you?*

YesNo

Anything else relevant you would like to share?

Where did you hear about us?*