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 LCMHC Associate Name and their corresponding number. Ensure all fields are completed to avoid delays.
In the General Information section, enter the Supervisor’s Name, Mailing Address, Business Phone, Email Address, and Mobile Phone using black ink or typed text.
For the Final Supervision section, input the Supervision Period by entering both Begin and End Dates. Check all modalities of supervision used.
Complete the hours for Supervised Professional Practice and Clinical Supervision as required. Make sure to adhere to the specified limits for indirect and direct counseling hours.
In the Supervision Summary section, provide a detailed summary of activities and evaluations of strengths and weaknesses. Attach additional pages if necessary.
Rate the applicant in the Professional Assessment section using the provided scale. Add comments where applicable.
Indicate your recommendation for licensure in the Reference section and provide reasons if not recommending.
Finally, verify all information is accurate in the Verification section before signing and dating it.

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