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 by entering the applicant's name in the designated fields: last name, first name, and middle name, along with the associate number.
3. Provide the dates of experience being claimed by filling in the 'From' and 'To' fields using the specified mm/dd/yyyy format.
4. Fill in the supervisor's information, including their name, license type, telephone number, license number, and state. Ensure to indicate the date they were first licensed.
5. Answer the relevant questions regarding the supervisor’s qualifications and the settings where the experience was gained by selecting the appropriate checkboxes.
6. Provide your employer’s information including the name, address, and business phone number, ensuring accuracy in all fields.
7. Answer questions related to the nature of the experience, such as the type of setting and whether the applicant was compensated or volunteered.
8. Indicate the number of weeks of supervised experience and the total hours of counseling, ensuring minimum and maximum requirements are met.
9. Review the entire form for completeness and accuracy. Have the supervisor sign the form and provide the date of the signature.
10. Save changes, and if necessary, download or print the completed form for submission.

Complete your documents online today for a smooth application process.