Get Cdp Verification Of Supervision Experience & Statement Of Qualifications. This Form Is Used To

This guide provides a clear and comprehensive overview of how to complete the CDP Verification Of Supervision Experience & Statement Of Qualifications form. Following these steps will ensure you accurately document your supervision experience for certification as a chemical dependency professional.

Follow the steps to accurately complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill out the applicant section by providing your last name, first name, and middle name, along with your birth date in the format mm/dd/yyyy. Enter your address details, including city, state, and zip code, followed by your phone number and business phone number.
3. In the direct supervisor section, include the supervisor's last name, first name, and middle name, along with their credential number and address details.
4. Next, document the supervised experience by specifying the start date and end date of your supervision in mm/dd/yyyy format. Include the supervisor's phone number and state abbreviation.
5. Detail the competencies you gained during your supervised experience, ensuring to mention that the first fifty hours of client contact were under direct observation. This is a vital requirement.
6. The supervisor must sign and date the form to attest to the accuracy of the information provided and to confirm meeting the supervisory requirements.
7. Complete the hours section for various experiences, including face-to-face clinical evaluation, other clinical evaluation, counseling sessions, and discussions of professional responsibilities. Make sure the total supervised experience hours are accurate.
8. Finally, review the qualifications section and have the supervisor complete their qualifications, ensuring they sign and date the document.
9. After completing the form, you can save changes, download, print, or share the document as needed.

Complete your CDP Verification Of Supervision Experience & Statement Of Qualifications form online today.