Name of Employer: Name: Position: Date commenced: Telephone: Date completed: Email: Job Title: Profession: Name of Employer: Name: Position: Date commenced: Telephone: Date completed: Email: AACBT CBT Clinical Practice Log (Cont’d) Employment details Name and contact details of a Type of CBT clinical practice (e.g., Estimated proportion of senior member of your Clinical practice with client, Supervision of time spent engaged in profession who you were CBT, Teaching or training, Research, Other) CBT-related activities accountable to. (%/total work hours/month) Job Title: Profession: Name of Employer: Name: Position:
Name of Employer: Date commenced: Date completed: Name: Position: Telephone: Email: Job Title: Name of Employer: Date commenced: Date completed: Profession: Name: Position: Telephone: Email: AACBT CBT Clinical Practice Log (Cont’d) Employment details Name and contact details of a senior member of your profession who you were accountable to. Type of CBT clinical practice (e.g., Clinical practice with client, Supervision of CBT, Teaching or training, Research, Other) Estimated proportion of time spent engaged in CBT-related activities (%/total work hours/month) Job Title: Name of Employer: Profession: Name: Position:
Accreditation-application-form_2016.docx