Supervision Handbook

Supervisee Leave of Absence Agreement

This Supervision Contract is by and between Christi Kersten, LPC-S (the “Supervisor”) and the Supervisee below.

Effective date Supervisee name

Purpose of leave

Leave time frame (start – end) Expected return date

The Supervisee shall maintain professional liability insurance during this leave, and shall not count any direct or indirect hours toward Council licensure requirements during this time.

Confirmation-of-return deadline

If the Supervisee does not confirm and return by the agreed-upon time frame, the Supervisor may extend the leave or terminate supervision (with 30 days to obtain a new supervisor).

Supervisee signature

Associate Signature

Date

Supervisor signature Date

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