Get Plan Of Supervision For Clinical Experience - Board Of Licensure For ... - Mft Ky

This guide provides a comprehensive overview of filling out the Plan Of Supervision For Clinical Experience form required by the Kentucky Board of Licensure for Marriage and Family Therapists. Follow the instructions to ensure accurate completion of the form.

Follow the steps to successfully complete your form online.

1. Press the ‘Get Form’ button to access the form and open it in your chosen document management tool.
2. Enter personal details in the first section, including your last name, first name, middle initial, street address, city, state, email address, associate permit number, zip code, and phone number.
3. Provide information regarding the primary clinical marriage and family therapy setting. This includes the agency name, street address, phone number, city, state, zip code, and a brief description of the agency’s function.
4. Specify the beginning and estimated ending dates of your supervision plan within the primary clinical setting.
5. If applicable, repeat step 3 for an additional clinical marriage and family therapy setting, providing the necessary details.
6. Input the board-approved supervisor’s information, including their name, street address, KY LMFT license number, city, state, zip code, and both home and work phone numbers.
7. In section A, provide a detailed description of the nature of the work setting, including types of activities and client demographics.
8. In section B, describe the nature, duration, and frequency of the supervision, detailing how and when sessions will take place.
9. In section C, outline the conditions or procedures for terminating the supervisory relationship.
10. State the number of hours spent per week in direct client-professional relationships, including diagnosis and treatment.
11. Ensure that the supervisor, applicant, and agency supervisor (if required) review and sign the respective statements confirming their responsibilities.
12. Finally, save your changes, and choose whether to download, print, or share the completed form as needed.

Complete your documents online to streamline your application process.