This form will be used to release information to your supervisor(s) regarding your provisional membership. This may include but is not limited to complaint issues, previous provisional licensure supervisor evaluations, etc.
I hereby give consent for the Saskatchewan College of Psychologists to release information to my named/approved supervisor(s) during my provisional practice period, regarding any information about my provisional membership and/or my competency to practice psychology.
Saskatchewan College of Psychologists
1026 Winnipeg Street, Regina, SK S4R 8P8Telephone: 306-352-1699/Fax: 306-352-1697Email: email@example.comWebsite: www.skcp.ca