Evaluation lpc 2026

1. Click ‘Get Form’ to open the evaluation LPC in the editor.
2. Begin by entering the applicant's name and email address in the designated fields at the top of the form.
3. In the Supervisor’s Evaluation section, input your name, license number, and license type. Ensure accuracy as this information is crucial for validation.
4. Provide the business name and address of the residency work site where clinical hours were obtained. Specify only one location.
5. Fill in the dates of supervision, including both start and end dates, ensuring they are formatted correctly (mm/dd/yy).
6. Complete all columns regarding hours worked, including total hours and any duplicated hours on another supervisor’s form.
7. Answer questions related to face-to-face client contact hours and supervision received. Be sure to indicate if applicable.
8. Respond to competency-related questions about assessment, diagnosis, treatment planning, case management, and ethics under your supervision.
9. If there are any concerns about the resident's competency, note them clearly on a separate page as instructed.
10. Finally, sign and date the form at the bottom before submitting it to ensure it is officially recognized.

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