Experience Standards 实践经经规定 - BACB

BACB Experience Standards – ver. 1/13/14 (BACB实践规规– 1/13/14版本)

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BEHAVIOR ANALYST CERTIFICATION BOARD

行行行行为为为为分析分析分析分析师师师师师师师师师师师师委委委委员员员员会会会会

- Experience Standards 实实实实践践践践经经经经经经经经规规规规定定定定 -

INSTRUCTIONS 规规规规定定定定说说说说明明明明

This document contains all of the standards and forms for experience used to qualify for BACB

certification. 对于行为分析师师师委员会（BACB）所有师师的规定说明及所需填写的实践经经表单，都包含在本文件内。

All experience used toward the requirements for BACB certification must meet these standards. The

BACB requires the supervisor and supervisee review this entire document together and discuss

any concerns before the experience begins.

BACB认认要求之所有实践经经，均需符合以下所列规定。。。。BACB要求督要求督要求督要求督导导导导和被督和被督和被督和被督导导导导人人人人员员员员在在在在开开开开始累始累始累始累计计计计实实实实践践践践经经经经经经经经之前，之前，之前，之前，必需必需必需必需共同共同共同共同审审审审审审审审本文件，并本文件，并本文件，并本文件，并讨讨讨讨讨讨讨讨协协协协协协协协任何相任何相任何相任何相关关关关之之之之顾顾顾顾顾顾顾顾。。。。

In addition to the experience-standards definitions, this document contains two forms for documenting

experience used toward BACB certification. They are: 除了说明实践经经规定的定义之外，本文件另包含两份表单以供记记师师所需之实践经经，两份表单为：

1. The Experience Supervision Form: This form, or equivalent, must be completed at least once

during each supervision period, throughout the duration of your experience. This form must

be duplicated with a copy retained by both the supervisor and supervisee. 实践经经督导表单：在整个累计经经期间的每次督导导间内，这份表单或等量表单填写完成必须至少一次。这份表单必须由督导人和受督导人各持相同的一份。

And 以及

2. The Experience Verification Form: This form should be completed at the conclusion of your

experience. If you have multiple experiences, you will need to complete multiple forms; one

for each experience/supervisor. The original, unaltered form must be submitted. Forms with

white-out or other alterations will not be accepted. Forms must bear the supervisor’s original

signature. Photocopies will not be accepted.

All applicants for certification must submit documentation of their experience using the

current version of the Experience Verification Form. Previous versions of the form will no

longer be accepted.


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实践经经师明表单：本表单应在你的实践经经累计计束导填写完成。如果你有多项实践经经，你需要填写多份表单，每一份用于每一项实践经经及每一位督导。将未修改之原始表单呈交给本委员会。若表单上有修正液或其他修改痕迹，将不被接受。表单上须有督导人员的原始签名。填写完复印的表单也不被接受。所有申请师师者必须呈交目前最新版本的实践经经师明表单，先前的版本不再被接受。

Initial exam applications should include Experience Verification Forms only. Do not submit the

Experience Supervision Forms completed during each supervisory period unless specifically

requested by the BACB. 首次考试申请应只包括实践经经核实表，除非除非除非除非BACBBACBBACBBACB特特特特别别别别要求，否要求，否要求，否要求，否则则则则不必呈交不必呈交不必呈交不必呈交每每每每次督次督次督次督导导导导导导导导导导导导完成完成完成完成之之之之实实实实践践践践经经经经经经经经督督督督导导导导表。表。表。表。


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EXPERIENCE CATEGORIES实践实践实践实践经经经经经经经经经经经经经经经经

SUPERVISED INDEPENDENT FIELDWORK (1500 hours BCBA, 1000 hours BCaBA): To

qualify under this standard at the BCBA level, supervisees must complete 1500 hours of Supervised

Independent Fieldwork in behavior analysis. To qualify under this standard at the BCaBA level,

supervisees must complete 1000 hours of Supervised Independent Fieldwork in behavior analysis. A

supervisory period is two weeks. In order to count experience hours within any given supervisory

period, supervisees must be supervised at least once during that period for no less than 5% of the

total hours spent in Supervised Independent Fieldwork. For example, 20 hours of experience would

include at least 1 supervised hour. 在督在督在督在督导导导导之下的独立之下的独立之下的独立之下的独立实实实实务务务务工作（工作（工作（工作（认认认认认认认认行行行行为为为为分析分析分析分析师师师师BCBABCBABCBABCBA需需需需1500150015001500小小小小时时时时，，，，认认认认认认认认副行副行副行副行为为为为分析分析分析分析师师师师BCaBABCaBABCaBABCaBA需需需需1000100010001000小小小小时时时时））））：：：：为符合BCBA等级之资格，受督导人必须完成1500小导在督导之下的行为分析独立实实工作。为符合BCaBA等级之资格，受督导人必须完成1000小导在督导之下的行为分析独立实实工作。一次督导期间为二星期二星期二星期二星期。在任何一次督导期间内可予计算的实践经经小导是，受督导人于二星期督导期间内，必须接受不少于在督导之下独立实实工作总导数之5%5%5%5%的至少一次至少一次至少一次至少一次督导。举例，20小导的实践经经就要包括至少1小导的受督导小导。

PRACTICUM (1000 hours BCBA, 670 hours BCaBA): To qualify under this standard at the BCBA

level, supervisees must complete, with a passing grade, 1000 hours of Practicum in behavior analysis

within a university practicum program approved by the BACB and taken for graduate academic

credit. To qualify under this standard at the BCaBA level, supervisees must complete, with a passing

grade, 670 hours of Practicum in behavior analysis within a university practicum program approved

by the BACB and taken for academic credit. A supervisory period is one week. In order to count

experience hours within any given supervisory period, supervisees must be supervised at least once

during that period for no less than 7.5% of the total hours spent in Practicum. For example, 20 hours

of experience would include at least 1.5 supervised hours. 实实实实实实实实课课课课程程程程（（（（BCBA1000BCBA1000BCBA1000BCBA1000小小小小时时时时，，，，BCaBA670BCaBA670BCaBA670BCaBA670小小小小时时时时））））：：：：为符合BCBA等级之资格，受督导人必须以及格分数通过并完成1000小导行为分析实实实。该实程需为BACBBACBBACBBACB核准核准核准核准之之之之大学实实实程，且为为士学程之学分。为符合BCaBA等级之资格，受督导人必须以及格分数通过并完成670小导行为分析实实实，该实程需为BACBBACBBACBBACB核准核准核准核准之之之之实实实实实实实实实实实实程程程程，且为修实之学分。一次督导期间为一星期一星期一星期一星期。在任何一次督导期间内可予计算的经经小导是，受督导人于一星期督导期间内，必须接受不少于实实实总导数之7.5%7.5%7.5%7.5%的至少一次至少一次至少一次至少一次督导。举例，20小导的经经就要包括至少1.5小导的受督导小导。

INTENSIVE PRACTICUM (750 hours BCBA, 500 hours BCaBA): To qualify under this standard

at the BCBA level, supervisees must complete, with a passing grade, 750 hours of Intensive Practicum

in behavior analysis within a university practicum program approved by the BACB and taken for

graduate academic credit. To qualify under this standard at the BCaBA level, supervisees must

complete, with a passing grade, 500 hours of Intensive Practicum in behavior analysis within a

university practicum program approved by the BACB and taken for academic credit. A supervisory

period is one week. In order to count experience hours within any given supervisory period,

supervisees must be supervised at least twice during that period for no less than 10% of the total

hours spent in Intensive Practicum. For example, 20 hours of experience would include at least 2

supervised hours.


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高密度高密度高密度高密度实实实实实实实实（（（（BCBABCBABCBABCBA750750750750小小小小时时时时，，，，BCaBABCaBABCaBABCaBA500500500500小小小小时时时时））））::::为符合BCBA等级资格，受督导人必须以及格分数通过并完成750小导之行为分析高密度实实，该实程必须为BACB核准之大学实实实程，且为为士学程之学分。为符合BCaBA等级资格，受督导人必须以及格分数通过，并完成500小导行为分析高密度实实，该实程需为BACBBACBBACBBACB核准核准核准核准之大学实实实程，且为修实之学分。一次督导期间为一一一一星期星期星期星期。在任何一次督导期间内可予计算的实践经经小导是，受督导人于一星期督导期间内，必须接受不少于高密度实实实总导数之10%10%10%10%的至少至少至少至少两两两两次次次次督导。举例，20小导的实践经经就要包括至少2小导的受督导小导

For all three of the above options, no fewer than 10 hours but no more than 30 hours, including

supervision, may be accrued per week. Supervisees may accrue experience in only one category per

supervisory period (i.e., Supervised Independent Fieldwork, Practicum, or Intensive Practicum). 以上三个选项每周所累计的导数，包括督导导间在内，不得少于10小导，不得多于30小导。受督导人每每每每一个督一个督一个督一个督导导导导期期期期导导导导只得在一个只得在一个只得在一个只得在一个选选选选选选选选中中中中累计实践经经。（亦即，在督导之下的独立实实工作，实实实程，或高密度实实。）

COMBINATION OF EXPERIENCE CATEGORIES: Supervisees may elect to accrue hours in a

single category or may combine any 2 or 3 of the categories above (Supervised Independent

Fieldwork, Practicum, Intensive Practicum) to meet the experience requirement, with Practicum

having 1½ times the temporal value of Supervised Independent Fieldwork, and Intensive Practicum

having 2 times the temporal value of Supervised Independent Fieldwork. 合并合并合并合并实实实实践践践践经经经经经经经经经经经经经经经经之之之之::::受督导人可以选选在单一类类或合并以上两个或三个类类（在督导下的独立实实工作，实实实程，或高密度实实。）中累计实践经经，以达到要求。在计算合并类类导数导，实实导间可相当于受督导的独立实实工作导间之1.5倍，高密度实实导间可相当于受督导的独立实实工作导间之2倍。


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STANDARDS 规规规规定定定定标标标标准准准准

ONSET OF EXPERIENCE: Supervisees may not start accumulating Supervised Independent

Fieldwork, Practicum, or Intensive Practicum hours until they have started attending courses required

to meet the BACB coursework requirements. 实实实实践践践践经经经经经经经经累累累累计计计计开开开开始始始始: 受督导人在开始修实BACB所需实程之前，不得开始累计受督导之独立实实工作，实实或高密度实实。

APPROPRIATE ACTIVITIES: The supervisee’s primary focus should be acquiring new behavior-

analytic skills related to the BACB Third Edition Task List or the BACB Fourth Edition Task List as

appropriate. Activities must be consistent with the dimensions of applied behavior analysis identified

by Baer, Wolf, and Risley (1968) in the article “Some Current Dimensions of Applied Behavior

Analysis” published in the Journal of Applied Behavior Analysis. The supervisor will determine if

experience activities qualify based on these sources. 符合符合符合符合规规规规定定定定的活的活的活的活动动动动:受督导人的主要注意焦点应为应取新的行新的行新的行新的行为为为为分析技能分析技能分析技能分析技能，这些技能视恰当情况与BACB第三版或与第四版工作表有关。活动必须与三位学者于1968年界定的应用行为分析面向一致。三位学者是Baer, Wolf,和 Risley，于1968年在＜应用行为分析期刊＞发表了文章《应用行为分析当前的一些面向》。督導人督導人督導人督導人根据根据根据根据这这这这些来源，将决定受督些来源，将决定受督些来源，将决定受督些来源，将决定受督导导导导人的活人的活人的活人的活动动动动是否合格。是否合格。是否合格。是否合格。

Supervisees are strongly encouraged to have multiple experiences (e.g., sites, populations) with

multiple supervisors and from each of the activity areas below. 我们们烈鼓励受督导人在多位督导之下，拥有多项经经（例如，不同地点，不同对象），以及在下列活动动域中，每一项都能累计实践经经。

• Conducting assessments related to the need for behavioral intervention (e.g., stimulus

preference assessment, functional assessment, staff performance assessment); 进行与行为干预有关的评估（例如刺激偏好评估，功能评估，工作人员员效评估）；

• Designing, implementing, and systematically monitoring skill-acquisition and behavior-

reduction programs; 设计，实施，技能采集之系统化监控，以及行为减少实程；

• Overseeing the implementation of behavior-analytic programs by others; 监督他人的行为分析计划施行情况；

• Training, designing behavioral systems, and performance management; 训训，设计行为系统，与员效管理；

• Other activities normally performed by a behavior analyst that are directly related to

behavior analysis such as attending planning meetings regarding the behavior analytic

program, researching the literature related to the program, and talking to individuals about

the program. 其他通常由行为分析师所做，直接与行为分析相关的活动，例如参加针对行为分析实程的计划会议，研究与实程相关的文献，以及与他人讨讨计划或实程。

Examples of activities that will not count as experience include: attending meetings with little or no

behavior-analytic content; providing interventions that are not based in behavior analysis; performing

nonbehavioral administrative activities; and completing nonbehavioral assessments (e.g., diagnostic


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assessments, intellectual assessments), paperwork, documentation, billing, or any other activities that

are not directly related to behavior analysis. 不会被计算为经经的活动举例如下：参加不具备或只具备很少行为分析内容的会议；提供并非以行为分析为基础的干预；进行与行为无关的行政活动；和进行与行为无关的评估（例如诊断评估，智力评估）；处理文书，记记，作帐，或其他不直接与行为分析有关的活动 No more than 50% of the total accrued experience hours can be in the direct implementation of

behavioral programs. 所累积的经经导数中不可有超过50%用在行为实程的直接执行上。

APPROPRIATE CLIENTS: Clients may be any persons for whom behavior-analytic services are

appropriate. However, the supervisee may not be related to the client or the client’s primary caretaker

or be the client’s primary caretaker. Supervisees must work with multiple clients during the

experience period. (Also, see the following relevant sections of the BACB Guidelines for Responsible

Conduct for Behavior Analysts: 1.06, 1.07, 2.0, 3.01, 3.03, 3.04, 3.05, 4.0, and 9.07.) 符合符合符合符合规规规规定个定个定个定个案案案案（客（客（客（客户户户户））））：：：：个案主可能是任何适用行为分析服实的人，但是，受督导人不得与案主有亲戚关系，不得与案主的主要照顾者有亲戚关系，不得为案主之主要照顾者。在实践经经累计期间，受督导人必须和多位案主工作。（可参见下列相关的BACB行为分析师之责任行为准则，条文1.06, 1.07, 2.0, 3.01, 3.03, 3.04, 3.05, 4.0, 与 9.07）。

SUPERVISOR QUALIFICATIONS: During the experience period, the supervisor must be a Board

Certified Behavior Analyst or Board Certified Behavior Analyst-Doctoral in good standing. The

supervisor may not be related to, subordinate to, or employed by the supervisee during the experience

period. Employment does not include compensation received by the supervisor from the supervisee

for supervision services. (Also, see the following relevant sections of the BACB Guidelines for

Responsible Conduct for Behavior Analysts: 1.05, 1.06, 1.07, and 5.0.) 督督督督导导导导者的者的者的者的资资资资格格格格规规规规定定定定::::在经经累计期间，督导人必须是声誉良好的师师行为分析师BCBA或师师行为分析师－博士BCBA-D.于经经累计期间，督导不得为个案亲戚，不得为其属下，不得被其雇用。雇用关系不包括受督导人付给督导人，用以偿付督导服实的费用。（可参见下列相关的BACB行为分析师之责任行为准则，条文1.05, 1.06, 1.07, 与 5.0）。

NATURE OF SUPERVISION: The purpose of supervision is to improve and maintain the behavior-

analytic, professional, and ethical repertoires of the supervisee and facilitate the delivery of high-

quality services to his/her clients. Effective behavior-analytic supervision includes: 督督督督导导导导的的的的本本本本质质质质:::: 督导目的为增进并维维受督导人之行为分析的，专专的，与合乎伦理的整体表现，以及促进受督导人提供优优服实给他或她的个案。有效能的行为分析督导包括：

• Development of performance expectations 制定预期员效

• Observation, behavioral skills training, and delivery of performance feedback 观察，行为技能训训，提供员效反馈

• Modeling technical, professional, and ethical behavior 对受督导人示范技术上，专专化，和合乎伦理的行为

• Guiding behavioral case conceptualization, problem-solving, and decision-making repertoires


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指导受督导人的行为上概念，解决问问，和作决策的能力

• Review of written materials (e.g., behavior programs, data sheets, reports) 审核书写材料（例如行为计划，数据表，报告等）

• Oversight and evaluation of the effects of behavioral service delivery 监督与评量行为服实的效果

• Ongoing evaluation of the effects of supervision 对督导效果的持续评量

The supervisor must observe and provide feedback to the supervisee on his/her behavior-analytic

activities with a client in the natural environment during each required supervisory period. In-person,

on-site observation is preferred. However, this may be conducted via web-cameras, videotape,

videoconferencing, or similar means in lieu of the supervisor being physically present; synchronous

(real-time) observation is strongly encouraged. 督导必须就每一督导期间，受督导人在自然环境中与案主之间的行为分析活动，予以观察并提供反馈给受督导人。最好是督导者本人实地的观察。但是可以通过网路摄像，记像，视视会议或类似方法，代替督导者实地观察。我们们烈建议同步（实导）观察。

Supervision may be conducted in small groups for no more than half of the total supervised hours in

each supervisory period. Small groups are interactive meetings in which 2-10 supervisees who share

similar experiences participate in the supervision activities described above. If non-supervisees are

present during the meeting, their participation should be limited so as to increase the interaction

opportunities of supervisees. The remainder of the total supervision hours in each supervisory period

must consist of individual supervision. 督导可用小团体方式进行，导数不超过每个督导期间总导数的一半。小团体督导为互动会议方式，2-10名拥有相近实践经经的受督导人，共同参与上述之督导活动。如有非受督导人参加会议，他们的参与应应限于提高受督导人之间的互动机会。每一段督导期间，除此之外余下的督导导数都必须由个类督导方式构成。

SUPERVISION CONTRACT: The supervisee and supervisor must execute a written contract prior to

the onset of the experience. The purpose of the contract is to protect all involved parties and align

experience activities with the purpose of supervision described under Nature of Supervision (below).

The contract should: 督督督督导导导导合合合合约约约约：：：：在经经累计开始前，受督导人和督导人必须执行书面合约。合约之目的为保维所有参与各方，以及保持经经累计活动与督导性优所述目的（见以下）一致。合约应有：

• State the responsibilities of the supervisor and supervisee; and 载明督导人和受督导人的责任；及

• Include a description of the appropriate activities and instructional objectives; and 包括对适当活动的描述，以及教学目标；及 • Include the objective and measurable circumstances under which the supervisor will sign

the supervisee’s Experience Verification Form when the experience has ended; and 包括在客观与可测量的情况下，当实践经验累计期结束时，督导人会在实践经验证明核实表上签字；及

• Delineate the consequences should the parties not adhere to their responsibilities (including

proper termination of the relationship); and


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描述当一方或双方不遵守他们的责任（包括适当地终止关系）导，会发生的后果；及

• Include a statement requiring the supervisee to obtain written permission from the

supervisee’s on-site employer or manager when applicable; and 包括一份声明，要求受督导人在必要导须取得现现雇主或经理的书面许可；及

• Include an attestation that both parties will adhere to the BACB Guidelines for Responsible

Conduct for Behavior Analysts and the BACB Disciplinary and Ethical Standards 包括一份签计，表明双方将遵守BACB行为分析师责任行为准则，与BACB纪律与伦理标准。

The supervisee and supervisor are responsible for retaining and providing to the BACB, if

requested, a copy of the contractual agreement. 受督导人与督导人有责任保存此督导合约，在BACB要求导可以提供BACB此一份合约。

DOCUMENTATION OF ONGOING SUPERVISION: The supervisee and supervisor are

responsible for collecting documentation for each supervision period on the Experience Supervision

Form during each supervisory period. One form should be completed at the end of each supervisory

period. The BACB reserves the right to request this documentation at any time following an

individual’s application to take the certification exam. This documentation should NOT be submitted

with an exam application unless specifically requested by the BACB. 进进进进行中的督行中的督行中的督行中的督导导导导导导导导导导导导：：：：受督导人和督导人对每一督导期内的实践经经督导表单都负有收集文件记记之责，每一督导期计束导均应完成一份记记表。BACB保留权利，可以在申请人申请师师考试之后的任何导候要求该记记。申请考试导不需呈交该记记，除非BACB特类要求。

Supervisors may develop their own version of the Experience Supervision Form. These alternative

forms must include all of the following elements: 督导人可以制作自己版本的实践经经督导表单。这些替代表单必须包括所有下述元素：

• Date of each supervisory meeting 每一次督导会议的日期

• Duration of each supervisory meeting 每次督导会议的导间时度

• Format of each supervisory meeting (i.e., individual or small group) 每次督导会议的形式（即个类或小团体）

• An evaluation of supervisee performance 对受督导人员效（表现）的评量

• The total experience hours obtained during the supervisory period 每次督导期间取得之实践经经总导数

• The total individual and small-group supervision hours obtained during the supervisory period 每次督导期间取得之个类与小团体督导总导数

• Date lines for supervisor and supervisee indicating when the form was completed & signed 督导人与受督导人签字之日期栏，显示表单何导完成

• Signature lines for supervisor and supervisee 督导人与受督导人签字栏


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The supervisee and supervisor are responsible for retaining and providing to the BACB, if requested,

copies of supervision documentation. Supervision documentation should be retained for at least 7

years. 受督导人与督导人自行负责保有督导记记文件，并在BACB要求导提供文件，督导记记文件应保留七年。

The BACB Experience Standards and Forms were updated in September 2012. Please be sure to use

the current version, available in the Downloads section of www.bacb.com. All applicants for

certification must submit documentation of their experience using the current version of the

Experience Verification Form. Previous versions of the form will no longer be accepted.

BACB实践经经规定与表单曾于2012年九月更新，请确保使用目前最新版本，表格可在www.bacb.com 的下载 (Downloads) 栏目中得到。所有申请师师者必须呈交目前最新版本的实践经经师明表单，先前的版本不再被接受。

CONTESTED EXPERIENCE: If a supervisee is unable to obtain the signature of a supervisor on the

Experience Verification Form or disagrees with the total number of hours recorded on the form, the

supervisee may supplement his or her application with proof of the following: 具争具争具争具争執執執執性的性的性的性的实实实实践践践践经经经经经经经经：：：：如果受督导人不能取得督导人在实践经经核实表单上签字，或不同意表单所记记之总导数，受督导人可以在申请导请充下列师据：

a. A copy of the supervisory contract一份督导合约

b. Copies of the signed Experience Supervision Forms completed during the experience一份具名签字的，于经经累计期间完成的实践经经督导表单

c. Letters or other documentation from third parties who observed the supervisory relationship 由观察督导关系的第三方发出的信或其他文件

Supervisees also must provide the supervisor with copies of the documentation they are submitting to

the BACB and must include proof of provision of this information to the supervisor (e.g., certified

mail receipt along with a letter from the supervisee to the supervisor). The BACB may attempt to

contact the supervisor to confirm receipt of this information and to provide him or her with an

opportunity to address this matter in writing. Supervisors will be asked to provide documentation of

dissatisfaction/concerns regarding the experience previously provided to supervisees claiming a

contested supervision. If the application is denied based on the lack of proof of supervision,

supervisees will have a right to appeal this denial. 受督导人也需要将呈交给BACB的文件記錄提供副本给督导人，同导必须包括已提供该信息给督导人的师明，（例如挂号信收据，连同受督导人写给督导人的信。）BACB得尝试尝系督导人以确师收到该信息，并提供督导人以书面方式解释问问的机会。督导人将被要求提供记记，以显示对宣称对督导持异议的受督导人之不满意／有所担忧之处。


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((((BACB Experience Supervision Form) BACB实践实践实践实践经经经经经经经经督督督督导导导导表表表表

This form (or equivalent) must be completed at least once during each supervisory period. 本表本表本表本表单单单单（或（或（或（或等等等等同同同同表表表表单单单单））））必必必必须须须须在在在在每每每每次督次督次督次督导导导导期期期期间间间间至少完成一次至少完成一次至少完成一次至少完成一次

Supervisee受督受督受督受督导导导导人人人人:_________________________________ Supervisor督督督督导导导导人人人人:____________________________________

Supervisory Meeting Date(s) & Duration(s) 督督督督导导导导会面日期与会面日期与会面日期与会面日期与时时时时时时时时时时时时度度度度:_____________________________________________

Supervisory Meeting Format (check all that apply) 督督督督导导导导方方方方式式式式(可複可複可複可複选选选选): _____ individual个个个个别别别别 ______group团团团团体体体体

This document covers the supervisory period from 本文件函本文件函本文件函本文件函盖督盖督盖督盖督导导导导期期期期时时时时自自自自_____/_____/_____ to至至至至_____/_____/_____

Experience Hours Accumulated During This Supervisory Period于本督于本督于本督于本督导导导导期期期期时时时时内的内的内的内的实实实实践践践践经经经经经经经经时时时时数累数累数累数累计计计计 (complete all four lines) （四行全部填写）（四行全部填写）（四行全部填写）（四行全部填写）

A) Number of independent experience hours accumulated (excluding time spent with supervisor) 独立实践时数累计(与督导人互动时动不算): ______

Of the hours listed above, state the number spent in direct implementation of behavioral programs: 上述时数中，多少小时是用在行为为程的直接执行：_______

B) Number of individual supervision hours accumulated 个别督导时数累计: ______

C) Number of small-group supervision hours accumulated 小团体督导时数累计: ______

D) Total experience hours accumulated (add lines A through C) 总总总时数累计（Ａ至Ｃ栏相加）: ______ Characteristics of Supervision Conducted During This Supervisory Period (check all that apply)

于本督于本督于本督于本督导导导导时时时时时时时时内的督内的督内的督内的督导导导导要点（要点（要点（要点（适适适适用者均可勾用者均可勾用者均可勾用者均可勾选选选选））））

_____ BACB Task List skills covered (list Task numbers) 已涵盖之BACB工作任务表技能（列出工作号码）:

_____________________________________________________________________________

_____ Specific client(s) discussed已讨讨特定个案

_____ Client privacy protected已保护个案之隐私

_____ Observation of supervisee (video) 对受督导人之观察（视视录像）

_____ Observation of supervisee (in-person) 对受督导人之观察（现现）

_____ Supervisory discussion & feedback (in-person) 督导下的讨讨及反馈（现现）

_____ Supervisory discussion & feedback (remote) 督导下的讨讨及反馈（远距离）

_____ Readings阅阅: ______________________________________________________________________

Evaluation of Supervisee Performance对对对对受督受督受督受督导导导导人表人表人表人表现现现现之之之之评评评评量量量量:

S - Satisfactory满满满满意意意意 NI - Needs Improvement需要需要需要需要改改改改进进进进 U- Unsatisfactory不不不不满满满满意意意意 N/A - Not Applicable不不不不适适适适用用用用

S NI U NA

Arrives on time for supervision准准准准时时时时到到到到达达达达督督督督导导导导导导导导合合合合

Maintains professional and courteous interactions with秉秉秉秉持持持持专专专专专专专专化化化化及及及及有礼的互有礼的互有礼的互有礼的互动动动动:

Clients/consumers 和和和和个案个案个案个案／消／消／消／消费费费费者者者者

Other service providers和其他的服和其他的服和其他的服和其他的服务务务务提供者提供者提供者提供者

Coworkers 和同事和同事和同事和同事

Maintains appropriate attire & demeanor保持保持保持保持适适适适当穿着和言行当穿着和言行当穿着和言行当穿着和言行举举举举止止止止

Initiates professional self-improvement 会会会会主主主主动动动动从从从从事事事事自我自我自我自我专专专专专专专专的提昇的提昇的提昇的提昇

Accepts supervisory feedback appropriately 可以合宜可以合宜可以合宜可以合宜地接地接地接地接纳纳纳纳督督督督导导导导人的反人的反人的反人的反馈馈馈馈

Seeks supervision appropriately 会会会会适适适适当地当地当地当地寻寻寻寻求求求求督督督督导导导导

Timely submission of written reports 准准准准时时时时呈交呈交呈交呈交书书书书面面面面报报报报告告告告

Communicates effectively: 有效有效有效有效地地地地沟沟沟沟通通通通:

Written书书书书面上面上面上面上

Oral 口口口口语语语语上上上上 Demonstrates appropriate sensitivity to nonbehavioral providers 对对对对非行非行非行非行为为为为服服服服务务务务者展者展者展者展现现现现适适适适当的敏感度当的敏感度当的敏感度当的敏感度

Supervisee self-detects personal limitations受督受督受督受督导导导导人人人人可以自我檢可以自我檢可以自我檢可以自我檢查查查查个人之个人之个人之个人之局限局限局限局限

Supervisee self-detects professional limitations受督受督受督受督导导导导人人人人可以可以可以可以自我自我自我自我檢檢檢檢查查查查专专专专专专专专能力之能力之能力之能力之局限局限局限局限

Acquisition of target behavior-analytic skills具具具具备备备备对对对对于于于于目目目目标标标标行行行行为为为为的的的的分析技能分析技能分析技能分析技能

Overall evaluation of supervisee performance during this period (circle one): S NI U

受督受督受督受督导导导导人在本期人在本期人在本期人在本期间间间间内表内表内表内表现现现现之之之之总总总总体体体体评评评评量量量量（圈（圈（圈（圈选选选选一一一一项项项项））））


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Supervisee signature受督受督受督受督导导导导人人人人签名: _________________________________________ Date日期日期日期日期: _______________________________

Supervisor signature督督督督导导导导人人人人签名: ___________________________________________ Date日期日期日期日期: _______________________________

DO NOT SUBMIT THIS FORM TO THE BACB WITH THE EXAM APPLICATION 申申申申请请请请考考考考试试试试时时时时勿呈交勿呈交勿呈交勿呈交本表本表本表本表单单单单

SUPERVISOR AND SUPERVISEE MUST EACH RETAIN A COPY OF THIS FORM FOR AT LEAST 7 YEARS 督督督督导导导导人与受督人与受督人与受督人与受督导导导导人必人必人必人必须须须须各自各自各自各自保留保留保留保留本表本表本表本表单单单单至少七年至少七年至少七年至少七年


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BACB Experience Verification Form (BACB实践实践实践实践经经经经经经经经证证证证明明明明单单单单))))

SECTION 部分部分部分部分A

Use one form per experience. Applicants may accrue only one type of experience at a time. 每每每每一一一一项项项项实实实实践践践践经经经经经经经经使用一使用一使用一使用一份份份份表表表表单单单单. 申申申申请请请请人一次只能累人一次只能累人一次只能累人一次只能累计计计计一一一一种种种种方式的方式的方式的方式的实实实实践践践践经经经经经经经经.

Applicant’s Name申请人姓名: ， (Last Name 姓) (First Name 名) Experience Hours Accumulated (complete all three lines) 实实实实践践践践经经经经经经经经经经经经数累数累数累数累计计计计（三行全部填写）（三行全部填写）（三行全部填写）（三行全部填写）:

A) Number of independent experience hours accumulated 独立经经经数累计: _____

Of the hours listed above, state the number spent in direct implementation of behavioral programs: ____ 上述经数中，多少小经是用在行为为程的直接执行：_______

B) Number of supervision hours accumulated 督导经数累计: _____

C) Total experience hours accumulated (add lines A and B) 总经经经数累计（Ａ与Ｂ栏相加）: _____

Experience Type Obtained (check only one) 所所所所获获获获实实实实践践践践经经经经经经经经经经经经经经经经（只勾（只勾（只勾（只勾选选选选一一一一项项项项））））:

�� Supervised Independent Fieldwork 在督导下的独立实地工作

� BACB Approved University Practicum (transcript must show passing grade in approved courses)

BACB核准之大学实实为

� BACB Approved University Intensive Practicum (transcript must show passing grade in approved courses) BACB核准之大学密集实实为

Experience Time-Frame经经经经经经经经取得之取得之取得之取得之时时时时间间间间范范范范围围围围: Starting date起始日期起始日期起始日期起始日期（M／D／Y）_____ / _____ / _______

Ending date结结结结束日期束日期束日期束日期（月／日／年） _____ / _____ / _____ (Indicate specific date 写出明确日期，勿写“目前”)

Supervisor’s Name督督督督导导导导人姓名人姓名人姓名人姓名: _______________________________Supervisor’s Title职职职职职职职职: __________________________

Telephone督督督督导导导导人人人人电电电电电电电电号号号号码码码码:_______________________Experience Setting实实实实实实实实场场场场所所所所: _______________________________

City城市城市城市城市: _____________________________ State/Country省／国家省／国家省／国家省／国家: ________________________________

SECTION 部分部分部分部分B

Must be completed by supervisor必必必必须须须须由督由督由督由督导导导导人填写完成人填写完成人填写完成人填写完成

By signing below, I hereby attest that 经经经经由以下由以下由以下由以下签签签签名，名，名，名，本人本人本人本人谨谨谨谨此此此此证证证证证证证证:

• The applicant completed the experience as specified in this policy document under my supervision and in compliance

with all of the stated requirements. 申申申申请请请请人在人在人在人在本人本人本人本人督督督督导导导导下，完成本政策下，完成本政策下，完成本政策下，完成本政策规规规规定的定的定的定的实实实实实实实实经经经经经经经经，并，并，并，并达达达达成成成成所有列所有列所有列所有列举举举举的要的要的要的要求。求。求。求。

• I am the responsible supervisor designated in the supervision contract with this supervisee. 本人本人本人本人为为为为督督督督导导导导合合合合约约约约中中中中的的的的责责责责任督任督任督任督导导导导，，，，督督督督导导导导合合合合约约约约为为为为此受督此受督此受督此受督导导导导人与人与人与人与本人本人本人本人所所所所订订订订立立立立。。。。

• During the applicant’s experience I was a Board Certified Behavior Analyst 在申在申在申在申请请请请人累人累人累人累计计计计经经经经经经经经期期期期间间间间，，，，本人本人本人本人为为为为合格合格合格合格认认认认认认认认行行行行为为为为分析分析分析分析师师师师，，，，BCBA认认认认照号照号照号照号码码码码 # ______

Supervisor: By signing below, you attest that ALL of the information contained on this Experience Verification Form is true

and correct to the best of your knowledge. 督督督督导导导导人人人人: 经经经经由以下由以下由以下由以下签签签签名，名，名，名，你你你你证证证证证证证证证证证证份份份份表表表表单单单单包含之包含之包含之包含之所有所有所有所有信息均信息均信息均信息均为为为为尽尽尽尽你你你你所知的所知的所知的所知的真真真真证证证证而且正而且正而且正而且正确确确确。。。。

Printed Name of Supervisor督督督督导导导导人姓名人姓名人姓名人姓名:

Signature签签签签名名名名: Date日期日期日期日期:


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This document must bear the original signature of the supervisor. Photocopies, faxed, or emailed copies of this document will not be accepted.

Original documents that have been altered (white-out, strike-through, etc.) will not be accepted. Incomplete documents will not be accepted. 本文件必须须有督导人的原始签名。复印，传真，或电电副本均不被接受。被改造之原始文件（用修正液，画掉，等等）不被接受。不完整的文件不被接受。

Experience Standards 实践经经规定 - BACB

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