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									                           COSCA (Counselling & Psychotherapy in Scotland)
                                  16 Melville Terrace | Stirling | FK8 2NE
                                    t: 01786 475 140 f: 01786 446 207
                           e: info@cosca.org.uk w: www.cosca.org.uk

          COSCA COUNSELLING SUPERVISION CERTIFICATE COURSE
                     SUPERVISOR’S REPORT FORM

Name of Supervisee:…………………………………… Date: ……………………..

Name of Supervisor: ……………………………………………………………………

Supervisor’s
Contact details:      Phone: …………………………………………………………….
                      Email: ……………………………………………………………..
                      Address: ………………………………………………………….
                      ………………………………………………………………………

Dates of sessions undertaken with supervisee as part of COSCA Counselling Supervision
Certificate Course.




Information about yourself as supervisor:

   a)      When and with whom Counselling Diploma (or equivalent) gained.

   b)      When and with whom accredited?

   c)      Years practising as a counsellor/psychotherapist:

   d)      Average number of clients in past year per month:

   e)      Own supervision arrangements:

           With whom?
           How frequent?
           How long each session?

   f)      When and with whom supervision training undertaken?

   g)      What qualification gained?

   h)      How many years practising as a supervisor?

   i)      How many supervisees seen per month on average this year:

   j)      Any other information relevant to your practice as counsellor/psychotherapist or
           supervisor (e.g. work as trainer, publications, etc.) Submit separate sheet if
           necessary.

  June 2009
                          Charity Registered in Scotland No. SC018887
            Charitable Company Limited by Guarantee Registered in Scotland No. 142360




June 2009

								
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