Get Form 7 - Intern Supervised Clinical Experience Plan - State Of Oregon - Oregon

The Form 7 - Intern Supervised Clinical Experience Plan is essential for individuals seeking licensure in Oregon as professional counselors or marriage and family therapists. This guide provides you with a clear, step-by-step approach to complete the form online, ensuring that you meet all requirements to facilitate your application process.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Fill in your name in the ‘Applicant/Intern Name’ section, selecting either LPC intern or LMFT intern as applicable.
3. In the ‘Setting’ section, list the locations of your employer/practice site. Ensure to provide the agency name, location address, mailing address or PO Box, city/state/zip, telephone number, and email address for each location.
4. Complete the ‘Supervision Required’ section by noting the required supervision hours based on your client contact hours for the month. Include a brief description of the clients and counseling activities you will perform.
5. In the ‘Clinical Supervisor Information’ section, provide the supervisor's name, business address, phone number, and email. Include their mental health graduate degrees and the accreditation details.
6. Discuss the relationship with the supervisor. Indicate how long you have known the supervisor and whether you are related.
7. Address any disciplinary actions against the supervisor and list their years of clinical experience, along with their state license or national credential.
8. Complete the ‘Supervision Training’ section, listing any relevant training or coursework that meets the requirements.
9. Review the section detailing the responsibilities of both the supervisor and the intern, ensuring you understand and will comply with these obligations.
10. Affix your signature and the signature of your clinical supervisor, along with the respective dates.
11. Ensure that copies of the completed form are made for all signatories, and prepare to submit the form along with a Professional Disclosure Statement for each work location to the Oregon Board of Licensed Professional Counselors & Therapists.

Start completing your Form 7 online today to ensure your application is processed efficiently.