Verification of Substance Use Disorder Professional 2026

1. Click ‘Get Form’ to open the Verification of Substance Use Disorder Professional in the editor.
2. Begin by filling in the applicant's details. Enter the last name, first name, middle name, birth date, address, city, state, zip code, and both personal and business phone numbers.
3. Next, provide information about the direct supervisor. Fill in their last name, first name, middle name, credential number, street address, city, state, zip code, and phone number.
4. Document the supervised experience by entering the start and end dates for supervision. Specify competencies gained during this period as required.
5. Ensure to attest that the first fifty hours of face-to-face client contact were under direct observation by checking the appropriate box.
6. The supervisor must sign and date the form at the bottom to validate all provided information.

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