Follow the steps to complete the verification form.

1. Click ‘Get Form’ button to access the verification form and open it in the designated online editor.
2. In the first section, provide the name of the applicant for whom the verification is being completed. This must be filled out clearly to ensure proper identification.
3. Complete the general information section by providing your name as the supervisor, your title, and the agency where the supervised practice occurred. Include your license type and number, mailing address, business phone, and email address.
4. Move to the supervised professional practice section. Indicate the period of supervision by entering the start and end dates, and check all modalities of supervision you utilized, such as direct observation or co-therapy.
5. Document the total hours for both indirect and direct counseling. Ensure that the hours recorded adhere to the limits specified in the instructions, noting that indirect counseling hours cannot exceed 40 per week.
6. Provide a summary of supervision activities in the supervision summary section. Mention the strengths and potential deficits of the supervisee. If necessary, attach additional pages for thoroughness.
7. In the professional assessment section, rate the applicant on various characteristics using the provided scale from outstanding to not qualified. Be sure to include comments for clarity.
8. Indicate your recommendation regarding the applicant’s licensure status in the reference section, specifying if you do or do not recommend them for unrestricted licensure. If you do not recommend, provide clear reasons.
9. Finally, verify your information by signing and dating where indicated. Make sure to enclose the completed form in a sealed envelope, signing across the flap, before submitting it to the NC Board of Licensed Professional Counselors.

Complete your documents online to ensure a smooth verification process.