School Facility Consent

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VIRTUAL SUPERVISION CONSENT

School / Facility Consent for Virtual RBT Supervision

Please review the institutional requirements and provide the required authorization and signatures.

Facility & Supervision Information
1. Institutional Alignment & Scope

This agreement establishes the formal conditions under which remote behavior-analytic supervision may be conducted within the educational facility.

The facility grants permission for the RBT to establish a secure, electronic virtual interface so that the remote BCBA can perform mandatory clinical oversight without creating physical classroom traffic or disrupting standard educational workflows.

2. FERPA Compliance & Peer Privacy Mandates

To ensure compliance with the Family Educational Rights and Privacy Act (FERPA) and safeguard the privacy of third-party students, the following operational mandates must be strictly maintained.

Targeted Camera Positioning

The streaming or recording device must be positioned strictly to capture only the designated student and the RBT. Cameras must never scan the classroom or capture the faces or movements of peer students.

Acoustic Insulation Controls

The RBT must utilize unidirectional directional microphones or localized positioning to isolate session audio, ensuring surrounding student names or peer vocalizations are not captured or transmitted.

3. Administrative Emergency Override

Classroom instructors, lead therapists, and facility administrators maintain an absolute right to order the immediate termination or suspension of the electronic data stream if privacy concerns, classroom emergencies, or testing conditions arise.

4. BCBA Background Verification & Professional Standing

The supervising BCBA verifies that they maintain active board certification in good standing, hold all necessary state-level professional licenses, and possess fully cleared criminal background checks and child abuse clearances on file with the primary behavior-analytic agency.

Signatures