Get Tx Supervised Experience Documentation Upgrade Form 2022-2026

The TX Supervised Experience Documentation Upgrade Form is essential for documenting supervised hours earned under a temporary license, aiding users in upgrading to full licensure. This guide will help you navigate and complete the form with ease.

Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your name in the 'Associate’s Name' section. Ensure to include your last, first, and middle names.
3. Provide your Social Security number in the designated field. Enter it in the format: XXX-XX-XXXX.
4. Input your Associate License number, which is necessary for verification purposes.
5. Enter your date of birth using the MM/DD/YYYY format.
6. Sign the form by affirming that you understand the regulations and that all the information provided is truthful. Date your signature appropriately.
7. Next, the Board Approved Supervisor will fill out their section. They need to provide their name, LPC-S License number, state, and the date issued.
8. The supervisor must also enter their email address, phone number, and the expiration date of their license.
9. In Section B, the supervisor will list the number of months they supervised you, the hours of supervision provided, and hours of supervised experience accrued.
10. The supervisor will indicate whether they recommend you for licensure. If they do not, they must summarize any concerns and attach necessary documentation.
11. Finally, ensure the supervisor signs and dates the form. After reviewing all information for accuracy, save changes, and download the completed form for submission.

Complete your TX Supervised Experience Documentation Upgrade Form online today to progress towards your licensure.