Get Nj Proposed Plan Of Supervised Clinical Experience

Filling out the New Jersey Proposed Plan Of Supervised Clinical Experience is a crucial step for both supervisees and supervisors in the field of social work. This guide will provide clear and detailed instructions to help you complete the form online efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin with Section I, where you will enter the supervisee information. Fill in the supervisee's full name, address, daytime telephone number, email address, and licensed social worker license number along with the date of active status.
3. Proceed to Section II, which details the supervisor’s information. Here you must input the supervisor's full name, business name, and business address. Additionally, indicate their telephone number and email address.
4. In Section II, you will also answer specific questions regarding the supervisor's licensure in New Jersey, including their license number, years licensed, and whether they hold a valid license to supervise in the state.
5. Answer the remaining questions in Section II, pertaining to the supervisor's training, any disciplinary actions, and the number of individuals under their supervision.
6. Move to Section III to provide information on supervision. Specify where client contact and supervision will occur, the number of locations, and whether the supervisor is employed by the agency or business where supervision will take place.
7. Continue in Section III by providing the inclusive dates of supervision and confirming your agreement to maintain supervision notes and a client contact log.
8. In Section III, address the personal learning objectives and primary clinical duties for the supervisee, ensuring they align with the job description.
9. In the Certification section, both the supervisor and supervisee must sign and date the form to validate the information provided.
10. Lastly, attach the required documentation: the supervisee’s job description, a copy of the supervisor’s resume, and any necessary consent letters if applicable.
11. After completing and reviewing the form, save your changes, and choose to download, print, or share the completed document as needed.

Complete your NJ Proposed Plan Of Supervised Clinical Experience online today for a seamless submission process.