Intern Supervisor Application

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By submitting this form, I am confirming that all information is true and correct. I understand that AHTA has the right to verify all information and may request additional materials. By submitting this form, I agree to abide by the AHTA Code of Ethics and the AHTA Standards of Practice.:

First Name *

Last Name *

Phone 1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

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Are you a:

Are you currently working in the field of horticultural therapy:

What date were you professionally registered?

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Name of Facility (if currently unemployed, please list most recent place of employment). *

Type of Facility *

Address *

City *

State *

Zip *

Facility Email *

How long have you been employed at this site? *

Are you *

Please provide a brief statement of your supervision philosophy/methods. Horticultural therapy supervision is de/ned as the process of training another to function effectively in the role of a horticultural therapist. A philosophy of supervision encapsulates the beliefs about supervision that a horticultural therapy intern supervisor holds and includes concepts relating to the ) supervisor’s beliefs about people, how people develop and change, how horticultural therapy works, etc. *

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Name *

Date

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