#2464, Supervisor's Affidavit of Applicant's Competencies-Documentation of Clinical Experience Gaine-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the applicant's name and training license number at the top of the form. Ensure accuracy as this information is crucial for identification.
3. In the supervisor section, provide your name and licensure details. This establishes your authority and responsibility in supervising the applicant.
4. Fill in the dates during which you supervised the applicant. Use the date fields to specify both start and end dates clearly.
5. Indicate the total hours of supervised professional counseling experience and face-to-face client contact hours. Be precise to comply with regulatory requirements.
6. Describe the facility where the applicant gained client contact experience, along with a brief overview of their clinical responsibilities.
7. Finally, sign and date the form. If digital signing is not possible, print it out for a manual signature before submission.

Start using our platform today to easily complete and submit your Supervisor's Affidavit!