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Supervision Application with Natasha
This is to help us determine if virtual supervision with me is the best fit for you!
Please fill out the form below and we will respond within 72 hours! For any questions, please contact us at
bouchillonn@gmail.com
. Thank you!
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* Indicates required question
Email
*
Your email
Date
*
MM
/
DD
/
YYYY
First and Last Name
*
Your answer
What is your current profession?
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Your answer
Where are you located? (State/Country)
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Your answer
How long have you been in the ABA field?
*
Just starting!
1-5 years
6-10 years
10+ years
Are you in an ABA or BCBA/BCaBA program? If so, what one and how far are you along in program?
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Your answer
Rate your conceptual understanding of MO's and SD's
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1
2
3
4
5
Rate your conceptual understanding of when to use specific data collection methods, graphing, and interpretation of data?
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1
2
3
4
5
Rate your conceptual understanding of how and when to use specific data collection.
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1
2
3
4
5
How many fieldwork hours do you need to complete?
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Your answer
How many hours do you plan on earning per week?*
Please note, if you only receive 10 hours per week, you will still be supervised no less than 1.5 hrs per period.
*
10 hours
10-20 hours
20-30 hours (or more)
What days/times are you available for live supervision (via phone or video chat)
Sundays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Mondays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Tuesdays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Tuesdays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Wednesdays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Thursdays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Fridays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Saturdays
*
Morning (8-11am) EST
Afternoon (11-2pm) EST
Late Afternoon (2-6pm) EST
Evening (6-10pm) EST
Not available
Do you already work with a supervisor on some of your hours? If yes, how many hours are they supervising you per week/month?
*
Your answer
How many unrestricted (indirect) hours do you plan to be working on if you receive supervision with me?
*
Your answer
What areas do you wish to gain experience in? (choose all that apply)
*
Autism ABA Therapy
Organizational Behavior Management
ACT Acceptance Committment Therapy
Curriculum/ABA Assessments (VBMAPP, PEAK, AFLS, ABLLS-R, AIM, etc)
Social Skills Training
Challenging Behaviors / Functional Assessments (FA, IISCA/PFA, etc)
Other
Required
What level of supervision are you looking for? (Check all that apply)
*
Group and 1 on 1 Supervision
1on1 Supervision Only
Group Supervision Only
Required
What are your primary goals with supervision?
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Your answer
How soon do you want to begin supervision?
*
Your answer
Once we've reviewed your app, we will send you a link of days/times to chat if you want to proceed. If you have any other questions or comments to add, please place here. Thank you!
Your answer
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