Get Lpca Supervision Agreement - Lpc Ky

This guide provides a comprehensive overview of how to fill out the LPCA SUPERVISION AGREEMENT for licensed professional counselors in Kentucky. By following these clear steps, users can efficiently complete the form online and ensure that all required information is accurately submitted.

Follow the steps to successfully complete the LPCA supervision agreement.

1. Click 'Get Form' button to obtain the LPCA SUPERVISION AGREEMENT and open it in your preferred editing tool.
2. Fill in Section 1 with your applicant information. This includes entering your first name, middle name, last name, home telephone, work telephone, fax number, street address, email address, city, state, and zip code.
3. Proceed to Section 2, where you will enter the supervisor information. Provide their first name, middle name, last name, street address, email address, city, state, telephone number, and license type. Additionally, include the license number, date of issue, and expiration date. Indicate whether the supervisor holds a designation as a licensed professional clinical counselor supervisor, the current number of LPCA supervisees, and attach any necessary documentation.
4. In Section 3, describe your supervised experience. Start by filling in your position title and the name of the organization or agency where the experience will be gained. Include their street address, city, state, and zip code. Indicate the average number of hours expected to be worked per week and select the type of setting for your experience.
5. Specify the type of counseling experience you need to gain by checking all that apply, such as rehabilitation, child and adolescent, general, marriage and family, and others. Provide detailed descriptions of both the direct responsibilities and the supervision focus necessary for the supervisory experience.
6. Review all sections for completeness and accuracy. Ensure all statements are affirmed regarding your understanding of the agreement and responsibilities.
7. Sign and date the form where indicated as the applicant. Ensure your supervisor also signs and dates in the specified area.
8. Once the form is fully completed, save your changes, and choose whether to download, print, or share the form as required for submission.

Complete your LPCA supervision agreement online today and ensure your professional journey continues smoothly.