Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the document and open it in your digital editor.
2. Begin by filling out the applicant's information. Indicate the name of the individual for whom the supervised professional practice form applies, ensuring to print or type in black ink.
3. In section I, provide general information about the supervisor, including their name, title, agency name, license type and number, mailing address, issue date, business phone, and email address.
4. In section II, detail the supervision period by entering the start and end dates. Select the modalities of supervision used by checking all applicable options.
5. Complete the hours of indirect and direct counseling sections. Ensure that the total hours for indirect counseling do not exceed 40 per week, and fill in the necessary details regarding clinical supervision hours.
6. In section III, summarize the supervision activities completed with the supervisee, highlighting their strengths and potential areas for improvement. Use additional pages if necessary.
7. Proceed to section IV and rate the applicant on characteristics including individual counseling skills and ethical conduct using the provided scale. Add comments to clarify your ratings.
8. In section V, indicate whether you recommend the applicant for unrestricted licensure by checking the appropriate box, and provide reasons if you do not recommend.
9. Finally, complete section VI by verifying the accuracy of the information provided, signing the document, and entering the date.
10. After filling out the form, enclose it in a sealed envelope, sign across the sealed flap, and submit it as instructed.

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