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How to use or fill out LPC- #F75-10963 Supervised Experience Documentation Form with DocHub
- Click ‘Get Form’ to open the LPC- #F75-10963 Supervised Experience Documentation Form in our editor.
- Begin by filling in your personal information in the 'Intern' section, including your name, Social Security number, and Intern License number. Ensure accuracy as this information is crucial for processing.
- Answer the questions regarding your legal history honestly. If you answer 'Yes' to any question, prepare to attach a detailed explanatory statement and certified court documents.
- In Section A, have your supervisor complete their details, including their name, LPC-S License number, and contact information. This section must be filled out by a board-approved supervisor only.
- Proceed to Section B where your supervisor will document the total hours of direct and indirect counseling. Ensure that they confirm the required supervision hours were met.
- Finally, review all sections for completeness and accuracy before signing at the bottom of the form. Your signature affirms that all provided information is true.
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