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Bbs supervision agreement form

37a 522 statement 2026

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The document outlines the responsibilities and requirements for supervisors of Associate Clinical Social Workers in California, as mandated by Title 16, California Code of Regulations. It details the qualifications a supervisor must possess, including licensure status, experience in psychotherapy, completion of supervision training, and understanding of relevant laws. The supervisor is required to develop a supervisory plan, monitor the associate's work, and provide assessments while ensuring compliance with regulations. The document concludes with a declaration under penalty of perjury affirming the supervisor's qualifications.

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Click ‘Get Form’ to open the 37a 522 statement in the editor.
Begin by entering the Associate’s Name and ASW Number at the top of the form. This identifies the individual under supervision.
Next, input the Supervisor’s Name and select their license type from the options provided, ensuring you include the correct License Number and Issue Date for each relevant license.
Carefully read through each responsibility listed in sections 1 to 14. Confirm that you meet all criteria before checking off each statement as applicable.
At the bottom of the form, print your name, sign, and date it. Ensure that all information is accurate and complete before submission.
Finally, provide a copy of this signed statement to the associate prior to starting any supervision.

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Versions	Form popularity	Fillable & printable
2020	4.9 Satisfied (40 Votes)
2018	4.4 Satisfied (132 Votes)
2010	4.3 Satisfied (158 Votes)

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