Get Supervised Experience Documentation Form. Forms And Form Information - Dshs State Tx

This guide is designed to assist users in accurately completing the Supervised Experience Documentation Form required for licensure as a professional counselor in Texas. With clear instructions, you will navigate each section of the form with ease.

Follow the steps to properly complete the form.

1. To obtain the form, locate and click the ‘Get Form’ button to access the Supervised Experience Documentation Form in your chosen document editor.
2. Begin by filling out the applicant's personal information, including the full name, preferred mailing address, phone number, Social Security number, intern license number, and date of birth. Ensure that all information is accurate to avoid processing delays.
3. Document the name and address of the agency or organization where you gained the required supervised experience. It is essential to have a separate experience form for each supervisor or site.
4. Next, the supervisor must fill out the section designated for them, including the dates of the applicant's supervised counseling experience, ensuring that only hours after the issuance of the temporary license are documented.
5. Indicate the number of hours of weekly face-to-face supervision provided to the applicant. Also, total the clock-hours of indirect and direct counseling experience. Add these to obtain the overall supervised experience hours.
6. The supervisor will need to specify the type of employment setting that applies, selecting one or more of the provided options including hospital, school, governmental agency, nonprofit organization, or private practice.
7. The supervisor must confirm if they provided supervision during the claimed dates, agree on whether a written supervision agreement exists with the board, and check if supervision met board requirements regarding face-to-face sessions.
8. Finally, the supervisor will indicate any reservations about the applicant being granted a license and provide a printed name, address, phone number, and signature, followed by the date the form is completed.
9. Once all sections are filled out, save your changes, then choose to download, print, or share the completed form as necessary.

Complete your documentation online to ensure your licensure process continues smoothly.