Supervised work experience documentation form - Texas ... - dshs state tx 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Counselor Intern Information. Fill in your name, Social Security Number, and mailing address clearly. Ensure all details are accurate.
3. Next, provide the Counselor Intern Registration Effective Date and Expiration Date. This information is crucial for processing your application.
4. In the CTI Site Information section, input the CTI Headquarters Name, CTI#, site name, and contact details. Make sure to double-check for any typos.
5. For Training Information, specify the Dates of Service, hours worked per week, and job title during this timeframe. Attach a copy of the job description as required.
6. Complete the Qualified Credentialed Counselor Information section by indicating if you provided direct supervision to the intern and include any necessary comments.
7. Finally, ensure that both you and the CTI Coordinator sign and date the form before submission to maintain compliance with DSHS requirements.

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