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The document is a Supervised Work Experience Documentation Form for Counselor Interns (CIs) in Texas, requiring detailed information about the intern, their job title, training hours, and supervision details. It must be submitted to the Texas Department of State Health Services along with the intern's job description. The form includes sections for counselor intern information, site information, training details, and signatures from both the Qualified Credentialed Counselor and CTI Coordinator. It emphasizes timely submission and documentation of hours worked.

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