MFT In-State Experience Verification Option 1 - Board of ... 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'APPLICANT NAME' section, ensuring you include your last, first, and middle names.
3. Fill out the 'SUPERVISOR INFORMATION' section with your supervisor's details, including their name, business phone, license type, and license number.
4. Indicate whether the hours reported were earned pre-degree or post-degree by marking the appropriate box.
5. In the 'EXPERIENCE INFORMATION' section, provide the dates of experience being claimed and specify how many weeks of supervised experience are being claimed.
6. Complete the hours of experience section by detailing total direct counseling experience and non-clinical experience as required.
7. Ensure all information is accurate before signing. Have your supervisor initial any changes made to the form.

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