Get Lpc Proposed Plan Of Supervision Form

Filling out the Lpc Proposed Plan Of Supervision Form online is a crucial step in establishing a supervisor-supervisee relationship in the field of professional counseling. This guide provides clear and practical instructions to ensure you accurately complete each section of the form.

Follow the steps to successfully complete the Lpc Proposed Plan Of Supervision Form.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering the applicant's name, including their last name, first name, and middle initial, in the designated fields.
3. Provide the applicant's address, including the street or P.O. Box, city, state, and ZIP code.
4. Fill in the supervisor's information, including their last name, first name, middle initial, and any other applicable names.
5. Indicate the business name and type of business (nonprofit, for profit, group, private, etc.), followed by the business address, city, state, ZIP code, telephone number, and email address.
6. Attach the supervisor's current resume or curriculum vitae. If the supervisor is licensed in another state, request an official letter of good standing from the issuing licensing board.
7. Indicate qualifications by checking the applicable boxes under the qualified supervisor section, and attach any required verification documentation.
8. Complete the licensure section by documenting the types of licenses or certificates held by the supervisor, including all relevant details such as the license number and issuing state.
9. Answer the questions regarding the status of the supervisor's licenses, the location of client contact and supervision, and the graduate school attended.
10. Address any potential conflicts of interest that may affect the supervisor's objective assessment of the applicant.
11. Provide the proposed number of direct client contact hours and the number of supervision hours planned weekly.
12. Specify the inclusive dates for the proposed supervision and outline the supervisory modalities that will be utilized.
13. Confirm the maintenance of weekly supervision notes and describe the services being contracted.
14. Verify if the applicant and supervisor have read the relevant statutes and regulations governing professional counseling.
15. Document the personal learning objectives of the supervisee.
16. Indicate whether the supervisee will have more than one supervisor, and if so, advise the supervisee to obtain a separate form from the other supervisor.
17. Finally, both the applicant and proposed supervisor must sign and date the form to certify that all information is accurate.

Complete your Lpc Proposed Plan Of Supervision Form online to streamline your supervision process.