Hello May Practicum Students!

Please read this document in full and reach out if you have any questions. It will need to be
submitted by May 14, 2020 in order to remain registered for your May practicum term.

During May term, you will be required to fulfill the following requirements:

1. 30 hours per week of work (including Simmons supervision time)

2. Direct observations (via telehealth, role play, video, or in-person)
3. A sufficient number of unrestricted hours
a. Approximately 50% as outlined by the BACB
b. This equals out to approximately 15 hours per week (with supervision)

If, for some reason, you are unable to meet these requirements or your experience hour plan
changes in any way during the semester (i.e. at risk of not being able to accrue sufficient hours),
then you will need to be withdrawn from the course. Incompletes will not be offered for the
summer semester due to a shortage in countable experience hours.

In order to ensure that these requirements can be met, you and your employer must sign this
form and return it below prior to May 14, 2020. Failure to do so will result in a course
withdrawal. I have included a course calendar here so you may review it with your clinical
supervisor.

Please submit your document here with completed acknowledgments (on the following page):
https://docs.google.com/forms/d/e/1FAIpQLSdOEWSwSpSYtWuvOJCEGxpM-
DyAS5aNu08Z_WI34eNGe7kyAQ/viewform?usp=sf_link
Clinical Supervisor Summer Acknowledgement:

I________________________________________________________ can confirm that

(Clinical Supervisor Name)

_________________________________________________________ will be able to fulfill the

(Simmons Student Name)

requirements of the Simmons practicum in the May term.

____________________________________________ ____________________
(Clinical Supervisor Signature) (Date)

Student Summer Acknowledgment:

I________________________________________________ acknowledge that if I can’t meet

the Simmons practicum Requirements, this will result in course withdrawal.

_____________________________________________ _______________________
(Simmons Student Signature) (Date)