Get Board Of Psychology - Verification Of Experience Form - California ...

The Board Of Psychology - Verification Of Experience Form is essential for individuals seeking to validate their supervision experience within the field of psychology in California. This guide provides clear, step-by-step instructions for users to complete the form accurately and effectively online.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. In Section I, enter the supervisee's information. Include their last name, first name, middle initial, and any aliases. Additionally, provide their date of birth.
3. Indicate the method of accrual of supervised professional experience by checking the appropriate box: Psychological Assistant, Psychologist, Psychological Intern, or an alternative setting.
4. Fill in the name of the employer and state of employment. Provide details for the primary supervisor, including their name, contact number, and address.
5. Complete the primary supervisor’s details, entering their degree, license type, license number, issue date, and jurisdiction.
6. If applicable, list any other licenses held in different states during the supervision period.
7. Document the dates of supervision in the format mm/dd/yy. Indicate the total number of weeks worked and the average number of hours worked per week. Calculate the total hours for the entire period.
8. In the duties section, provide a detailed description of the psychological duties performed during the supervised experience.
9. In Section III, answer all questions related to supervision experience as the primary supervisor. Be prepared to indicate compliance with legal and ethical standards.
10. Finally, declare the performance rating of the supervisee and sign the form. Ensure the signature reflects the name printed or typed and include the date.
11. Once all sections are completed, you can save your changes, download a copy for your records, print the form, or share it as necessary.

Complete your documentation online today to ensure your experience is properly validated.