Get Tx Supervised Work Experience Documentation Form 2008

This guide provides clear and supportive instructions for completing the TX Supervised Work Experience Documentation Form online. Follow these steps to ensure that your form is filled out accurately and submitted properly.

Follow the steps to successfully complete the form:

1. Press the ‘Get Form’ button to access the TX Supervised Work Experience Documentation Form and open it in your online editor.
2. Begin by entering the counselor intern information. Provide the full name, including last, first, and middle names. Fill in the social security number and date of birth accurately.
3. Record the counselor intern registration effective date and expiration date in the appropriate fields.
4. In the CTI site information section, complete the CTI headquarters name and CTI number, followed by the site name, telephone number, and full site address including city, state, and zip code.
5. Input the training information. Specify the dates of service in the format 'From' and 'To.' Enter the job title held during the specified time frame and remember to attach a copy of the CTI job description for that job title.
6. Indicate the hours worked per week and the total clock hours accrued in the KSA domains for the claimed period, excluding holidays.
7. As the Qualified Credentialed Counselor, answer if you provided direct supervision to the intern. If not, indicate who did and provide their name and license number.
8. Respond to the question regarding any reservations you may have about the intern being granted a license as a chemical dependency counselor, and include any necessary explanations or additional comments.
9. Print your name, license number, and other credentials. Sign and date the form, affirming that the information provided is true and accurate.
10. Have the CTI coordinator complete their section by signing and dating the form, and including their LCDC number and other credentials.
11. Once completed, review the document for accuracy. You can then save your changes, download, print, or share the form as needed.

Complete your documentation online now to ensure timely processing!