Get Licensed Professional Counselor Supervisor Application Form - Dshs State Tx

Filling out the Licensed Professional Counselor Supervisor Application Form is an essential step for licensed professional counselors seeking to supervise LPC interns in Texas. This guide will provide clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to complete your application form successfully.

1. Click the 'Get Form' button to access and open the Licensed Professional Counselor Supervisor Application Form in your preferred online editor.
2. Begin by entering your name in the designated field at the top of the form. Ensure that you provide your full legal name as it appears on your state-issued identification.
3. Fill in your address, including street number and name, city, state, and zip code. Ensure that all information is accurate to facilitate correspondence.
4. Enter your telephone number, including the area code, and provide your email address in the specified fields. Confirm that your contact details are current and functional.
5. Input your LPC license number, issuance date, and expiration date. These details are crucial for verification purposes.
6. Review the qualifications for supervisor approval listed on the form and select the applicable box that verifies your education qualification or course completion. Attach any necessary transcripts or proof of completion as required.
7. Carefully read each statement of assurance provided in the form. Initial next to each statement to confirm your understanding and intent to comply with the Texas State Board of Examiners of Professional Counselors' regulations.
8. Affirm that all information included in the application is true and correct before signing and dating the application in the designated section at the bottom.
9. Prepare a check or money order for $100 to accompany your application, ensuring compliance with the fee requirement for processing.
10. Once all sections of the form are completed accurately and the payment is prepared, save your changes. You may download, print, or share the completed application as needed before submitting it according to the instructions provided.

Take the next step in your professional journey by completing the Licensed Professional Counselor Supervisor Application Form online today!