Get Tn Lpc Verification

Filling out the Tn Lpc Verification form is an essential step for users seeking verification of supervised post-masters experience. This guide provides detailed, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to correctly fill out the Tn Lpc Verification form.

1. Press the ‘Get Form’ button to access the Tn Lpc Verification form and open it in your browser for editing.
2. Begin by entering the name of the applicant in the designated field. Ensure that the name is spelled correctly.
3. Fill in the supervisor's name, address, email, and telephone number in the respective fields. It is crucial to ensure accuracy in these contact details.
4. Enter the supervisor's license number, state, and type of license. If the license is an M.D. or D.O., indicate if they are certified by the American Board of Psychiatry and Neurology.
5. Provide the date of the initial license and the expiration date. Additionally, answer whether the license is in good standing and disclose any disciplinary actions if applicable.
6. Specify the job title of the applicant during the supervision period, along with the dates supervision started and ended.
7. Detail the activities included in the clinical supervision by checking the appropriate boxes. Make sure to describe any activities listed under 'other'.
8. Indicate the location where the clinical experience took place and provide a thorough description of the clinical experience.
9. Accurately fill in the total hours for individual supervision, group supervision, and all supervision hours. Additionally, fill out the total clinical hours and any other hours related to paperwork or training.
10. Conclude by having the supervisor sign and date the form, certifying that the information provided is correct. Ensure the form is sent to the specified address.

Complete the Tn Lpc Verification form online today to ensure your eligibility for the licensing process.