Contested Experience/Fieldwork Form - BACB.com 2026

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The document is a Monthly Experience Verification Form used by the Behavior Analyst Certification Board (BACB) for trainees to report their supervised and independent fieldwork hours. It requires details such as trainee and supervisor names, experience type, and total hours worked. Both the supervisor and trainee must attest to the accuracy of the information provided, sign the form, and retain copies for at least seven years.

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Click ‘Get Form’ to open the Contested Experience/Fieldwork Form in our platform.
Begin by entering the Trainee Name at the top of the form. This identifies who is completing the experience.
Select the Experience Type from the provided options, ensuring you choose one that accurately reflects your situation.
Input your BACB Account ID for tracking purposes and select your Supervisor's Name and Qualification Type from the dropdown menu.
Fill in the Month/Year field to specify when this experience took place.
Record your Independent Hours and Supervised Hours in their respective fields, then calculate and enter the Total Experience Hours.
Both Supervisor and Trainee must sign and date the form at the bottom, confirming all information is accurate.

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