Follow the steps to effectively complete your application packet.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editing tool.
2. Begin by filling out your personal information in the designated fields: your first name, middle initial, last name, previous names (if any), street address, city, state/province, ZIP/postal code, and country.
3. Next, provide your home and business telephone numbers, and your email address. You may choose to opt-out of having your contact information shared with continuing education providers by checking the appropriate box.
4. Indicate your gender and date of birth by entering the required data in the specified format (mm/dd/yyyy). Optionally, you can provide your ethnic origin for statistical purposes.
5. Complete the sections regarding your academic achievements by listing all relevant degrees, including the date conferred, major, and the institution attended, ensuring you attach a copy of your transcripts.
6. Document your licenses and certifications by including the type, number, issue date, and expiration date. Ensure you attach copies of your licenses or certificates.
7. Fill out the ethics attestation section by truthfully answering each question regarding any criminal charges, legal actions, or employment issues. If applicable, compile necessary documentation to submit with your application.
8. Review and complete the Applicant Agreement & Release Authorization section, confirming that all information is accurate and acknowledging the corresponding consent.
9. If required, complete the coursework and mental health experience forms, ensuring to include details about clinical supervision training and relevant work experience. Attach any necessary verification documents.
10. Finally, review your entire application for completeness and accuracy. Once confirmed, save any changes, download the completed form, and prepare your payment. You can either print to mail or prepare for submission by fax.

Take the first step towards becoming an Approved Clinical Supervisor by completing your application packet online today.