Xaminers Professional Counselor Examiners Committee 124 Halsey Street, 6th Floor, P.O. Box 45044 Newark, New Jersey 07101 (973) 504-6582 Documentation of Supervised Counseling Experience (This form should be completed by the supervisor and forwarded directly to the Committee.) for: Licensed Professional Counselor Candidate Licensed Rehabilitation Counselor Candidate Please print clearly. Information about the applicant.
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How to fill out the NJ Documentation Of Supervised Counseling Experience online
The NJ Documentation Of Supervised Counseling Experience is a crucial form for individuals pursuing licensure as professional or rehabilitation counselors in New Jersey. This guide provides a step-by-step approach to effectively complete the form online, ensuring all necessary information is accurately presented.
Follow the steps to complete the form with ease.
- Press the ‘Get Form’ button to access the form and open it in the editor.
- Begin by filling in the applicant's information, including their last name, first name, middle initial, and maiden name if applicable, along with their complete street address, city, state, ZIP code, telephone number including area code, and email address.
- Next, fill in the supervisor's information using the same format as the applicant. Provide their last name, first name, middle initial, maiden name if applicable, street address, city, state, ZIP code, telephone number including area code, email address, and their license or application number.
- Indicate whether the supervisor holds a clinical mental health-related professional license in New Jersey by answering 'Yes' or 'No'. If 'Yes', check the appropriate professional designation.
- If the supervisor is licensed in another state or jurisdiction, answer the corresponding question and provide the necessary details about the license.
- Include information about the graduate school attended by the supervisor, along with their major and highest degree earned.
- Answer whether any circumstances may affect the objective assessment of the applicant. If ‘Yes’, provide an explanation on a separate sheet of paper.
- Complete the section about the applicant's supervised experience, including tax status, name of setting, and contact details.
- Input the applicant's title during supervision, the inclusive dates of supervision, and total hours of supervised counseling completed.
- Indicate the average number of hours spent in face-to-face supervision and group supervision.
- Check the applicable activities performed during the supervision. Ensure to address various interactions and feedback methods used.
- Respond to questions regarding the applicant's performance and capabilities as a counselor by marking 'Yes,' 'No,' or 'Not observed' for each ability.
- On a separate sheet, assess the applicant's preparedness for licensure and provide recommendations for their professional development.
- Finally, the supervisor must sign and date the document, confirming the truthfulness of the information provided. Provide comments if necessary.
Complete your NJ Documentation Of Supervised Counseling Experience online for a smooth application process.
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