Get Cadc Proposed Plan Of Supervision

This guide provides clear and supportive instructions for completing the Cadc Proposed Plan Of Supervision online. By following these steps, you will ensure that your application is filled out accurately and efficiently.

Follow the steps to complete your Cadc Proposed Plan Of Supervision online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by confirming whether the intern has read the regulations regarding alcohol and drug counselor internships. Clearly select ‘Yes’ or ‘No’.
3. The supervisor must also indicate if they have read the relevant regulations. Record their response by selecting ‘Yes’ or ‘No’.
4. Fill in the date of completion in the designated field.
5. In the 'Intern Information' section, provide the name of the intern including last name, first name, and middle initial.
6. Enter the mailing address of the intern accurately, including street or P.O. Box, city, state, and ZIP code.
7. Record the home telephone and cellular telephone numbers of the intern, ensuring to include the area codes.
8. Inquire about the completion of core-training hours. Fill in the number of completed hours from the total of 270.
9. Indicate if the intern holds a college or university degree by selecting ‘Yes’ or ‘No’.
10. Select whether the intern currently holds another clinical license, marking ‘Yes’ or ‘No’.
11. Specify the proposed internship or worksite setting by checking the appropriate box, such as ‘Division of Addiction Services Licensed Agency’ or ‘Private/Group Practice’.
12. Provide the name and address of the work/internship setting, ensuring accuracy in the street address and contact number.
13. In the 'Proposed Supervisor' section, enter the name and address of the proposed supervisor, including their telephone number.
14. Indicate whether the supervisor is C.C.S. credentialed by selecting ‘Yes’ or ‘No’.
15. Check all applicable licensure categories for the proposed supervisor.
16. Answer whether the proposed supervisor has any license restrictions or past disciplines from professional boards.
17. Check the modalities of supervision planned, selecting all that apply.
18. Ensure both the supervisor and intern sign the form and record the date of signing.
19. Attach required documents such as resumes, a program brochure, and a copy of the written internship agreement as specified.
20. Review all entered information for accuracy, then save changes, download, print, or share the completed form as needed.

Complete your Cadc Proposed Plan Of Supervision online today to ensure a smooth internship application process.