Learning and Supervision Plan for Accreditation via Leadership Training

Your Name (required)

Address (required)

Email (required)

Work Phone

Home Phone

Mobile Phone

Professional Qualifications

Professional associations

Evidence of professional indemnity

Confirmation of membership of the BSANZ

Name and contact details of your Supervisor (required)
(A plan is required for each supervisor)

Supervisor's Name (required)

Supervisor's Email (required)

(The appointment of the Supervisor must be confirmed by the Accreditation Committee and done in consultation with the trainee.)

Date of commencement of supervision

(Format dd/mm/yyyy)

Details of the proposed Balint group experiences

(include the following information: Number, duration and frequency of Balint group meetings)

Details of member and leadership roles at Balint group meetings

Your proposed participation at Balint leadership Annual Residential Workshops

Arrangements for the trainee to contact the Accreditation Committee within the first 12 months of training

Other additional arrangements

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