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2009 IA Supervised Clinical Experience: Approval and Attestation-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin with Part 1, where the supervisor must fill in their name, mailing address, phone number, and email address. Ensure all fields are completed accurately.
- Next, the supervisor should provide their education and license information, including title, degree/major, university attended, and license/certification details.
- In the section for recent clinical experience, input the employer's name and state along with the duration of employment. Specify the type of setting.
- Continue by detailing the planned supervised experience dates and employment settings. Include agency names, addresses, phone numbers, and email addresses as required.
- For professional duties under supervision, describe tasks clearly. If more space is needed, feel free to add additional pages.
- Finally, both supervisor and applicant must sign and date their respective attestations at the end of each part before submitting the form to the Iowa Board of Behavioral Science.
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