ACI Supervisor’s Report Pre-Accreditation - Addiction Counsellors of Ireland

Notice to Clinical Supervisor: You are advised to read the applicant’s completed application
form and Addiction Counsellors of Ireland Code of Ethics prior to completing this form.

CONFIDENTIAL

1. Clinical Supervisor’s Personal Details:

Name

First

Last

Address

City

State/Province

Zip/Postal

Country

Phone

Qualifications:

Supervisor’s Accrediting Body

Counselling Experience

Experience as Supervisor

2. Applicant’s Personal Details: Pre Accreditation

Name

First

Last

Address

City

State/Province

Zip/Postal

Country

3. How long have you been supervising the applicant?

Individually:

From:

In a group:

To:

From:

4. How often do you meet the applicant for supervision?

Weekly

Fortnightly

Monthly

Length of session?

1 hour

1½ hours

2 hours

5. What is the method/model of your supervision? (e.g. Case notes/review of sessions/counselling in presence of supervisor/use of video tape recording etc.)

6. Do you consider the applicant has sufficient training and experience for pre accreditation as a counsellor?

7. Do you consider that the applicant has sufficient self-knowledge and discipline to be an able and responsible counsellor?

8. Do you consider the applicant has shown competency and necessary skills to counsel?

9. What do you consider makes the applicant a competent counsellor?

10. Are you satisfied that the applicant will counsel in accordance with ACI Code of Ethics and Practice?

11. Do you believe the applicant is committed to on-going personal development?

12. Is there any reason, in your opinion, why the applicant should not be pre accredited by ACI or Membership renewed at this time?

13. Any other comments?

Signature of Clinical Supervisor:

I confirm that I have read the applicant’s application for accreditation/pre-accreditation/renewal of accreditation. It is, to the best of my knowledge, accurate.

Supervisor Signature

Clear

Date

Signature of Applicant:

Clear

Date