Get Exp-mft.pdf. Mft Experience Verification Form - Pacifica

Filling out the MFT Experience Verification Form is a critical step in the process of obtaining your marriage and family therapist licensure. This guide offers clear, step-by-step instructions to ensure that you complete the form accurately and thoroughly, making the process approachable for everyone.

Follow the steps to accurately complete the MFT Experience Verification Form

1. Press the ‘Get Form’ button to access the MFT Experience Verification Form and open it in your preferred document editor.
2. Begin the form by entering the applicant's name in the designated section at the top.
3. Next, the supervisor must provide their name, address, and business telephone number. Ensure that all information is typed or printed clearly.
4. Fill in the name of the applicant’s employer and the employer’s address and business telephone number. Again, clarity in this section is essential.
5. Respond to the questions regarding the experience setting. Indicate whether the experience was gained in a lawful mental health counseling setting and if it occurred in a private practice.
6. Document the dates for which the experience is being claimed. Use the provided fields for 'From' and 'To' to specify the timeframe.
7. Indicate the total number of weeks of supervised experience you are claiming on the form.
8. In the logged hours section, fill out the hours for various categories of experience: individual counseling, couples or family work, group counseling, and any relevant administrative activities.
9. Ensure that each entry is accurate and corresponds with your weekly summary of hours.
10. Complete the supervisor's license type, number, state, and date originally licensed. If applicable, answer the psychiatric certification question.
11. Finally, sign and date the form to validate its accuracy before submission, ensuring it is done under penalty of perjury.

Complete your MFT Experience Verification Form online to streamline your licensure application.