CONTESTED EXPERIENCE/FIELDWORK FORM

The Contested Experience/Fieldwork form may be completed when a supervisor refuses or is unable to sign the Final Experience/Fieldwork Verification Form, even though all supervision contract terms have been met. This form may only be used to contest signature of the Final Experience/Fieldwork Verification Form and should not be used to contest signature of Monthly Experience/Fieldwork Verification forms or to appeal a determination made by BACB staff. Information provided in the form may be shared with the supervisor(s) for verification purposes.

If you are a supervisor seeking guidance on how to handle a dispute with your trainee regarding signing their Final Experience/Fieldwork Verification Form, please refer to "Experience/Fieldwork Verification Forms: Preventing Disputes Between Supervisors and Trainees" on p. 1 of the August 2019 BACB Newsletter.

Before completing this form, you should:

1. 1. 1. Attempt to resolve the matter with your supervisor(s). In the event that the issue is not resolved, retain documentation of your attempt to include with your submission.
      2. Review the terms of your supervision contract.
      3. Collect any signed Monthly Experience/Fieldwork Verification forms that you have for the period in question, along with any documentation that provides evidence that supervision took place.
      4. Determine if there was an ethical violation related to experience/fieldwork which may be reported by filing a Notice of Alleged Violation (NAV).
      5. Determine if this is a matter of a contractual dispute that may need to be addressed through an independent legal process.