Get Lmft Out Of State Experience Verification Option 1. Lmft Out Of State Experience Verification

Completing the LMFT Out Of State Experience Verification Option 1 form is a necessary step for applicants seeking licensure in California. This guide provides clear instructions on filling out the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your chosen online editor.
2. Begin by filling in your personal information in the 'Applicant Name' section, including your last name, first name, and middle name, along with your intern number.
3. In the 'Supervisor Information' section, enter your supervisor's last name, license type, license number, and the date they were first licensed. Additionally, input the supervisor's business phone and address, including city, state, and zip code.
4. Indicate whether you were supervised by a certified psychiatrist during the entire period of supervision by selecting ‘Yes’ or ‘No.’ If 'Yes,' provide the date you were board certified.
5. In the 'Applicant’s Employer Information' section, fill in the name and address of your employer, as well as the business phone number.
6. Provide the dates of your experience by filling out 'From' and 'To' dates in the mm/dd/yyyy format.
7. Specify how many weeks of supervised experience you are claiming.
8. Record your total hours of experience, ensuring to breakdown direct counseling hours and non-clinical experience. Confirm that you meet the minimum requirements, including hours diagnosing and treating couples, families, and children.
9. The supervisor must sign the form, and the signature must be original. If there are any changes made, the supervisor must initial those revisions. Include the date next to the supervisor’s signature.
10. Once you have completed the form, review all entries for accuracy. You will then have the option to save your changes, download, print, or share the completed form as needed.

Complete your documents online for a smooth application process.