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  • Clinical Supervisor Exemption Request - Azbbheus

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STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS 3443 NORTH CENTRAL AVE., SUITE 1700 PHOENIX, AZ 85012 PHONE: 602.542.1882 FAX: 602.364.0890 Board Website: www.azbbhe.us Email Address: information.

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How to fill out the CLINICAL SUPERVISOR EXEMPTION REQUEST - Azbbheus online

Completing the CLINICAL SUPERVISOR EXEMPTION REQUEST is an essential task for individuals seeking exemption status in clinical supervision. This guide provides a comprehensive, step-by-step process tailored to facilitate users through filling out the form accurately and efficiently.

Follow the steps to successfully complete your exemption request form.

  1. Click the ‘Get Form’ button to obtain the exemption request form and open it in the editor.
  2. Fill in your name in the designated field at the top of the form, followed by your phone number and address.
  3. Provide your current AzBBHE license number along with its expiration date in the respective fields.
  4. Select one of the two options regarding your application status. Indicate whether you have submitted an application for licensure or if you anticipate applying for independent level licensure in the future. Be sure to fill in the required dates for application submission or projected application.
  5. Enter the name of your proposed Clinical Supervisor and detail the licenses they hold along with their expiration dates.
  6. Document the agency or entity where your supervised work experience was or will be acquired, including the address and the size of the agency/entity in number of employees.
  7. Indicate which exemption category applies to your request by checking the relevant box. Provide further details for your request where required.
  8. Ensure to include an explanation for your request in the designated section.
  9. Review the certification statement carefully. You must affirm the accuracy of the provided information by signing and dating the form at the bottom.
  10. Once completed, you can save the changes, download the form, print it, or share it as needed.

Complete your CLINICAL SUPERVISOR EXEMPTION REQUEST form online today for a smoother application process.

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Fill CLINICAL SUPERVISOR EXEMPTION REQUEST - Azbbheus

The following submissible form can be used to request an exemption to the Clinical Supervisor requirements in AAC R4-6-504 for applicants for LPC licensure. Lastly, you will need to fill out a Clinical Supervisor Exemption Request and file it with AZBBHE. "Clinical supervisor" means an individual who provides clinical supervision. Employment of clinical supervisor. Qualifications of the clinical supervisor. Provide direct, face-to-face clinical supervision to supervisees, ensuring compliance with Arizona Board of Behavioral Health Examiner (AZBBHE) regulations. Clinical supervisor is responsible to provide direct, clinical supervision, including thorough and regular reviews of all client records.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232