Get Nj Proposed Plan Of Supervision For C.a.d.c./l.c.a.d.c. Internship_dsa

Filling out the NJ Proposed Plan Of Supervision for C.A.D.C./L.C.A.D.C. internship is a crucial step in the journey towards becoming a credentialed alcohol and drug counselor. This guide will provide you with clear, step-by-step instructions to successfully complete the form online.

Follow the steps to complete the form accurately

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by confirming whether the intern has read the regulations related to Alcohol and Drug Counselor internships by selecting 'Yes' or 'No'.
3. Next, ensure that the supervisor has read the regulations for clinical supervision by selecting 'Yes' or 'No'. Enter the date of completion in the provided field.
4. Fill in the intern's personal information, including their last name, first name, middle initial, mailing address, home telephone number, and cellular telephone number.
5. Indicate the number of core-training hours in Addiction Studies that the intern has completed out of the required 270 hours.
6. Determine whether the intern holds a degree from a college or university by selecting 'Yes' or 'No', while including this information in the attached resume.
7. Select whether the intern is a credentialed intern by answering 'Yes' or 'No' and including this information in their resume.
8. Specify the proposed internship worksite setting by checking the appropriate box that applies.
9. Provide the name and address of the work/internship setting, as well as the telephone number.
10. Fill out the supervisor’s name, address, and telephone number while confirming if the supervisor is credentialed by checking 'Yes' or 'No'.
11. Mark the licensure status of the proposed supervisor by checking all applicable licenses.
12. Indicate whether the supervisor has had any license restrictions or disciplinary actions by selecting 'Yes' or 'No'.
13. List the modalities of supervision planned, checking all that apply.
14. Both the supervisor and the intern must sign and date the form.
15. Attach the required documents to this application, including the resumes of both the intern and supervisor, a brochure of the agency/program, and the written Internship Agreement.
16. After completing all fields and attaching necessary documents, save changes, download, print, or share the form as needed.

Complete your NJ Proposed Plan Of Supervision for C.A.D.C./L.C.A.D.C. internship online today!