Follow the steps to complete the MI LARA/BPL-MFT1000HRS form accurately.

1. Click ‘Get Form’ button to access the MI LARA/BPL-MFT1000HRS form and open it in the selected editor.
2. Enter the applicant’s date of birth in the designated field. Ensure the date is accurate and correctly formatted.
3. Fill in the applicant’s name, including the first, middle, and last name as required in the specified section.
4. Provide the name and complete address of the applicant’s place of employment. Ensure all details are clearly written.
5. Input the supervisor’s name in the appropriate fields, again including their first, middle, and last name.
6. Include the supervisor’s registration, license, or credential number, making sure it aligns with official records.
7. Specify the level of certification or licensure the supervisor held while providing supervision.
8. Detail the jurisdiction or organization that issued the supervisor’s license, ensuring correct complementation.
9. Record the date the supervisor's licensing was issued, using accurate date formatting.
10. If applicable, indicate whether the Board approved the special supervisory situation. If so, provide the date of approval.
11. In the certification and signature section, the supervisor must affirm that the applicant gained qualifying experience under their supervision while the supervisor’s license was in good standing.
12. Document the total number of hours of marriage and family therapy completed by the applicant in the designated space.
13. Indicate the start and end dates of the applicant’s therapy work experience, using the month/day/year format.
14. The supervisor must then provide their signature and title, along with the date of signing the document.
15. Review all provided information for accuracy before proceeding to save changes, download, print, or share the completed form.

Complete your MI LARA/BPL-MFT1000HRS form online today to move forward with your licensure process.