Get Au Chps-76 2020-2025

The AU CHPS-76 form is essential for provisional psychologists changing their principal supervisor during their internship. This guide will walk you through each section of the form to ensure accurate and timely completion.

Follow the steps to complete the AU CHPS-76 form online.

1. Click ‘Get Form’ button to access the AU CHPS-76 form and open it in your preferred editor.
2. In Section A, fill in the provisional psychologist's details including name, registration number, and email. Then, provide the outgoing and incoming principal supervisors' information, ensuring each has their name, registration number, and email listed.
3. Indicate whether the incoming supervisor is a Board-approved principal supervisor for the internship programs by selecting 'YES' or 'NO'. Provide the reason for the change of principal supervisor in the designated field.
4. Proceed to Section B, noting the commencement date for this reporting period, which includes the period since the last progress report or the start date of the internship. Enter the conclusion date of this reporting period as well.
5. List the current approved workplace(s) where the provisional psychologist is working, including the organization's name and hours worked per week.
6. Detail the total hours worked during the internship, filling in individual categories such as hours of client contact, supervision, and professional development. Be sure to include cumulative hours.
7. Indicate the number of times supervisors directly observed the provisional psychologist during training. Enter the number of observation sessions for both assessment and intervention services.
8. Report the hours of telephone or indirect supervision completed during this period, alongside cumulative hours.
9. Provide the number of case reports or studies submitted and assessed as satisfactory by the Board.
10. In Section C, comment on the provisional psychologist's progress towards achieving competency in the eight core competencies of the internship program. If comments exceed the space provided, attach a separate document as necessary.
11. In Section D, the outgoing principal supervisor must declare the accuracy of the information, providing their name, signature, and date.
12. In Section E, the incoming principal supervisor must confirm their awareness of the provisional psychologist's progress and either agree to continue under the current internship plan or indicate a new plan will be submitted. Include their name, signature, and date, as well as the provisional psychologist's signature and date.
13. Once all sections are completed, review the form for accuracy. Save the changes, and you may choose to download, print, or share the completed form as needed.

Complete your AU CHPS-76 form online today to ensure a smooth transition in your internship supervision.