Get Supervisor Registry Request - State Of Oregon - Oregon

Filling out the Supervisor Registry Request can be a key step in establishing your role as a supervisor in Oregon. This guide provides a thorough walkthrough of each section of the form to help you complete it accurately.

Follow the steps to successfully complete the Supervisor Registry Request online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by entering your personal information. Fill in your name, agency name, location address, mailing address, city, state, zip code, telephone number, and email address. Ensure all contact details are accurate for future correspondence.
3. In section A, list your supervision experience over the past five years. Include the names of registered interns, graduate students, counselors, or therapists you have supervised, along with the corresponding dates of supervision.
4. Proceed to section B for your national supervisor credential. Fill in the certification title, issuing organization, certification number, original issue date, and expiration date accurately.
5. In section C, provide details of your supervision training. List the post-masters training you've completed, including the title of classes, workshops, or seminars, the sponsoring organization, the date taken, and the number of clock hours completed.
6. If you plan to supervise LMFT interns, describe any graduate-level training in systemic theory and approaches related to couples and family issues.
7. Answer the question regarding your qualifications to work with interns who have disabilities or speak other languages. Provide detailed responses to reflect your capabilities.
8. In section D, review and acknowledge your responsibilities as a supervisor by ensuring you comprehend all outlined duties, which include compliance with administrative rules and providing thorough clinical supervision.
9. Finalize the form by certifying that the information you provided is true and correct. Sign and date the document. Make sure that your signature matches the name provided in the header of the form.
10. Once you have completed the form, save any changes you made. You may also choose to download, print, or share the form as necessary.

Complete your Supervisor Registry Request online today to ensure your qualifications are recognized.