ADST 5P74/76 – Practicum Change Form

Please complete this form if you have a change to your ADST 5P74/ADST 5P76 practicum. If your situation is not captured below please reach out to adspracticum@brocku.ca.

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Reminders:

If your BCBA supervisor is also your Site supervisor – please only complete the BCBA supervisor forms.

Practicum BCBA Supervisor:

A Board Certified Behaviour Analyst (BCBA) OR Board Certified Behaviour Analyst -Doctoral Level (BCBA-D)who has completed the required 8-hour, competency-based training covering the BACB’s Supervisor Training Curriculum Outline. The Practicum BCBA Supervisor is responsible for supervising and monitoring the students’ practicum-related activities (i.e., assignments, supervision forms, etc) and provides the required supervisory contact during the supervision period.

Practicum Site Supervisor:

An onsite supervisor who is NOT the practicum student’s BCBA/BCBA-D supervisor. The Practicum Site Supervisor may provide clinical and/or administrative supervision and support to the student and should work in collaboration with the Practicum BCBA Supervisor.

(Please note: Many supervisors will be both the Practicum BCBA Supervisor and the Practicum Site Supervisor, i.e., the Supervisor is a BCBA and works onsite with the student. However, students who receive BCBA supervision from an external BCBA/BCBA-D will require a Practicum Site Supervisor, i.e., the BCBA supervisor does not work in the same agency or in the same department as the student, so the student has a supervisor at their practicum setting and an external BCBA supervisor.)

Practicum Site Director:

Agency or Program Director of the practicum site who has the authority to approve the practicum placement (e.g., Clinical Director, Program Director).

  • If this number is not pre-populated, please fill it in. You can find this number in the Student's Agreement email you received.
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  • Nature of the practicum change:
    If this applies to you, please visit https://brocku.ca/social-sciences/applied-disability-studies/practicum/ and begin the process form the beginning.
  • Nature of the practicum change:
    If this applies to you, please provide the following information:
  • Nature of the practicum change:
    If this applies to you, please provide the following information:
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