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Get Ca Bbs 37a-201 2019-2026

A B C 9. Was one additional hour of face-to-face individual or two hours of face-to-face group supervision given for every week in which more than 10 hours of face-to-face psychotherapy was performed Yes 37A-201 Rev. 04/2015 SUPERVISOR INFORMATION Supervisor s Name License Type License Number Date First Licensed 1. STATE OF CALIFORNIA - BUSINESS CONSUMER SERVICES AND HOUSING AGENCY Governor Edmund G* Brown Jr. Board of Behavioral Sciences 1625 North Market Blvd. Suite S200 Sacramento CA 95834 Telephone 916 574-7830 TTY 800 326-2297 www. bbs. ca*gov CLINICAL SOCIAL WORKER EXPERIENCE VERIFICATION Your supervisor must complete this form as follows o Use a separate form for each supervisor and employer o Provide an original signature in ink and have the signer initial any changes o Make sure this form is complete and correct prior to signing All information on this form is subject to verification APPLICANT NAME ASW APPLICANT S EMPLOYER INFORMATION Applicant s Employer s Name Address Busine....

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How to fill out the CA BBS 37A-201 online

The CA BBS 37A-201 form is an essential document for applicants seeking licensure in clinical social work in California. This guide provides step-by-step instructions on how to complete the form accurately and efficiently, ensuring that all necessary information is included.

Follow the steps to complete the CA BBS 37A-201 form online.

  1. Press the ‘Get Form’ button to access the CA BBS 37A-201 form and open it in your document management system.
  2. Fill in your personal information in the 'Applicant Name' and 'ASW Number' fields. Ensure that your name is clearly written as it appears in official documents.
  3. Provide your employer's information, including the name, address, telephone number, as well as the city, state, and zip code. Double-check for accuracy.
  4. Answer the questions regarding the clinical setting. Select 'Yes' or 'No' for the two questions provided about the setting's compliance with oversight and requirements.
  5. Enter the supervisor information, including the supervisor's name, license type, telephone number, license number, email address (optional), state, and the date they were first licensed.
  6. Indicate if the supervisor was employed by your employer and if there was a written agreement regarding oversight. Select the appropriate options.
  7. Document the dates of experience using the mm/dd/yyyy format. Provide the total supervised weeks and total hours in both individual or triadic supervision and group supervision.
  8. Complete the fields regarding clinical experience, ensuring that the minimum required hours for each category are accurately reported.
  9. Answer the last question regarding additional supervision requirements, selecting 'Yes' or 'No' as appropriate.
  10. Sign and date the form. Ensure the signature is original and not a digital or stamped signature, and confirm that all information is accurate before submission.
  11. Once completed, save the changes to the form. You can also download, print, or share it as required for your application.

Begin completing your CA BBS 37A-201 form online today to ensure your application for licensure is submitted accurately.

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