Follow the steps to accurately complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Part A, where you, as the applicant, should enter your name, including first, middle, and last names. Also, provide your Social Security number.
3. Next, fill in your complete address, including number, street, city, state, and zip code.
4. Indicate the credential you are applying for by checking the appropriate box: LCDC II, LCDC III, or LICDC.
5. Provide the name and title of your supervisor in the designated fields.
6. Enter the name and address of the facility where your supervision took place.
7. Fill in the dates of supervision at the setting, specifying the month and year for both the start and end dates.
8. Provide the approximate size of your alcoholism and other drug addiction caseload.
9. Estimate the percentage of time spent on counseling functions related to alcoholism and drug addiction.
10. Complete and sign the Waiver of Liability section with your name and today's date.
11. Once Part A is complete, give the form to your supervisor to fill out Part B.
12. The supervisor should provide their professional credentials and review the applicant's statements for accuracy.
13. The supervisor should also indicate awareness of any unethical behavior and their recommendation for certification.
14. After the supervisor completes their section, they should sign and date the form.
15. Once complete, you can save your changes, download your copy, print it, or share the form as necessary.

Complete your documents online to ensure a smooth application process.