Final supervision: Fill out & sign online

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Click ‘Get Form’ to open the final supervision report in the editor.
Begin by filling in the LPC Associate Name and LPCA number at the top of the form. Ensure all information is accurate.
In Section I, provide your Supervisor’s Information, including your name, mailing address, business phone, email address, and mobile phone.
Move to Section II and enter the Supervision Period dates. Check all modalities of supervision used during this period.
Complete the hours for Supervised Professional Practice and Clinical Supervision as per the guidelines provided.
In Section III, summarize the supervision activities and identify strengths and potential deficits of the supervisee. Attach additional pages if necessary.
Proceed to Section IV for Professional Assessment. Rate the applicant on various characteristics using the provided scale.
Finally, complete Sections V and VI regarding recommendations and verification. Sign and date where required before submission.

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