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Contract for Mentorship: The Happy Medium Approach
This contract describes the relationship between Eclipse Therapy, LLC, Mentor, and Individual Name, client acquiring Mentorship post eligibility requirement for a BACB credential. This mentor and client DO NOT work in the same service-delivery environment.
This Mentorship agreement is made on the date of signed below between Eclipse Therapy, LLC (mentor) and Individual Name (client) for mentorship related to the delivery of applied behavior analysis services.
Appropriate activities may include the following; the mentor will discuss with the client which additional activities qualify. Activities covered in behavior analytic supervision including Observation and data collection • Training staff and caregivers on behavior-analytic programs or content • Conducting assessments related to the need for behavioral intervention • Meeting with clients about behavior-analytic programming and services • Conducting behavior-analytic assessments (e.g., functional analyses, stimulus preference assessments) • Data graphing and analysis • Researching the literature relevant to a current client’s programming • Writing and revising behavior-analytic programs
Instructional objectives will be determined by the mentor and client related to the client’s place of service delivery and could include the following:
RESPONSIBILITIES AND AGREEMENTS
_____These recordings will not be used except for training and supervision purposes
_____These recordings will not be shared with anyone except the mentor
_____These recordings will not contain identifying information of students or clients
Confidential Information. On and after the date of this agreement, mentor and client shall keep confidential all information relating to current or potential clients including, but not limited to, any medical or clinical information, in whatever form. Mentor and client shall be jointly responsible for ensuring that other clients have consented to the observation of service delivery and sharing of confidential client information if this becomes relevant.
Mentor Records. All records related to the activities described in this contract are and shall remain the property of Eclipse Therapy, LLC Client shall not, except in the ordinary and usual course of their duties and obligations under this agreement, remove from mentor’s premises, copy, or retain any of Eclipse Therapy, LLC records. Upon termination of the agreement, the client agrees to return promptly to Eclipse Therapy, LLC any of Eclipse Therapy, LLC records, copies of records, and all other property that is in client’s possession or under their control or custody.
TERM AND TERMINATION
Term. This agreement shall be effective on May 30th, 2022 (date) and shall remain in effect until either party terminates this agreement by 30 day’s advance written notice to the other of the intention to terminate. In the event of termination Clause, 14 shall survive and remain valid.
Entire agreement. This agreement contains the entire agreement between the Parties hereto with respect to the subject matter hereof.
This section is reserved for selected miscellaneous provisions regarding topics important to contract interpretation and enforcement. Research into enforceable contracts in your state should help you select contract provisions to address the following provisions:
Modifications – Modifications may be requested to this agreement in writing and sent to Eclipse Therapy, LLC, 2091 Kerr Gulch Rd, Evergreen, CO 80439
Severability – If one clause is stricken by implication of law, the remaining clauses of the contract will still be considered valid.
Notice under this agreement by one Party to another Party shall be in writing and considered effectively given if personally delivered or deposited via postal service, postage prepaid, certified or registered, return request, and addressed to the recipient as follows:
Mentor mailing address: Eclipse Therapy, LLC 2091 Kerr Gulch Rd Evergreen, CO 89439
Client mailing address: on receipt
The responsibilities described in this document will be carried out in accordance with the BACB’s Guidelines for Responsible Conduct for Behavior Analysts and Professional Disciplinary and Ethical Standards.
All parties agree to the stipulations herein
Mentor Name & Credentials (printed): Rosalie Prendergast, MS, BCBA (Certification # 1-09-5801)