Get Application Packet For Initial Supervision Lmft Effective ... - Dhp Virginia

Filling out the Application Packet for Initial Supervision as a Licensed Marriage and Family Therapist (LMFT) in Virginia requires careful attention to detail. This guide provides clear, step-by-step instructions to help users complete the application thoroughly and accurately, ensuring a smooth submission process.

Follow the steps to complete your application packet effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling out your legal name, alternative names used on official documents, and your public address. Ensure all sections are completed before moving on.
3. Indicate your sex by circling the appropriate option provided in the application. Input your date of birth, home phone, cell phone, and business phone including your email address.
4. Enter your Social Security number or Virginia DMV number correctly, as applications without these details will not be processed.
5. List all graduate schools you attended in chronological order, including the institution name, the degree earned, major, and the dates of attendance.
6. Complete the Ethics Attestation by answering the five questions regarding any past licensing issues or criminal convictions. If any answers are affirmative, provide necessary explanations on a separate sheet.
7. Provide your Supervisor’s Information, including their name, license number, type, business address, and contact information. Ensure that your supervisor is listed on the Supervisor Registry, otherwise submit evidence of their supervision training.
8. Complete the worksite information section by specifying where you will provide clinical marriage and family therapy services. Confirm that this position meets the requirements set forth by the LMFT Regulations.
9. Review the Statement of Assurance and ensure all parties involved understand their responsibilities. Obtain original signatures from both the resident and supervisor.
10. Prepare all required supplemental documentation (education verification, coursework, supervisor evidence) along with the completed application and check for the $65 application fee.
11. Once all sections are filled out and required documents are attached, review the entire application carefully. Save changes, download, print, or share the completed packet as needed.

Complete your application packet online today to ensure timely processing of your initial supervision as an LMFT.