Definition and Purpose
The "Documentation of Post-Graduate Clinical Experience Supervisor's Affidavit" is a formal document used to verify the post-graduate clinical experience of applicants seeking social work licenses under the supervision of qualified practitioners. This affidavit is essential for applicants applying for licensure through the Wisconsin Department of Safety and Professional Services, particularly within the realm of Marriage and Family Therapy, Professional Counseling, and Social Work. It serves as an affidavit that authenticates the applicant's direct experience, capturing the depth and breadth of their clinical practice hours, supervision specifics, and competency evaluations across various social work practice domains.
How to Use the Affidavit
Using the Supervisor's Affidavit follows a systematic approach to ensure that all the required details are clearly captured and verified. The process typically involves:
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Collection of Details: Gather all necessary information about your post-graduate clinical hours, including timelines, the nature of clinical activities undertaken, and the identity of your supervisor.
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Supervisor's Information: Ensure your supervisor provides detailed personal information, including qualifications and licensure status, confirming their authority to supervise your clinical experience.
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Competency Evaluation: Your supervisor should evaluate and document your competencies in several practice areas per state regulations, showcasing your readiness for independent practice.
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Affidavit Completion: The supervisor completes the affidavit form by honestly and thoroughly documenting your clinical experiences and validating the authenticity of the information provided.
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Signature and Notarization: Both the applicant and the supervisor must sign the affidavit. Depending on state requirements, this may need to be notarized for further authenticity.
Steps to Complete the Affidavit
To ensure thorough and accurate completion of the affidavit, follow these comprehensive steps:
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Pre-Completion Review: Before starting, carefully review the form to understand all sections and gather all preliminary information needed for completion.
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Section-by-Section Entry:
- Begin with your personal details, including name and contact information.
- Follow with the description of your supervised clinical experience, clearly delineating dates, hours, and types of clinical activities performed.
- Allow your supervisor to complete their section, detailing their credentials and supervisory capacity.
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Competency Assessment: Request your supervisor to assess and document skills observed during your clinical activities. This should align with requisite competencies expected for licensure.
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Verification: Double-check all entries for accuracy and compliance with state requirements to prevent delays or rejection.
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Signing and Notarization: After thorough verification, sign the document alongside your supervisor. Ensure notarization if mandated by the state licensure board.
Who Uses the Affidavit
The primary users of the Supervisor's Affidavit are:
- Social Work License Candidates: Individuals aspiring to secure licensure for practicing social work at a professional level.
- Qualified Supervisors: Licensed professionals responsible for overseeing the candidate’s clinical practice period and verifying their expertise.
- State Licensure Boards: Entities that evaluate the completion of this affidavit to corroborate the applicant's eligibility for licensure.
Key Elements of the Affidavit
The affidavit is composed of crucial elements that substantiate the applicant's clinical capabilities:
- Applicant Information: Personal and contact details pivotal for identification purposes.
- Clinical Experience Log: Itemized account of clinical hours and associated activities conducted under supervision.
- Supervision Details: Information about the supervisor, their qualifications, and the supervisory methodology employed.
- Competency Evaluation: Evidence of competencies attained in key areas such as ethics, intervention strategies, and case management.
- Verification and Signatures: Final stages involve signatures from both parties to verify the entered information's authenticity.
State-Specific Requirements
While the affidavit serves a generic purpose, specific requirements may vary:
- State Regulations: Different states might have unique prerequisites concerning the documentation and format of the affidavit.
- Local Scope: Certain competencies or hours may need adjustment depending on local regulatory bodies.
- Verification Protocols: Some regions require more stringent procedures, like notarization or additional supporting documents.
Important Terms Related to the Affidavit
Understanding key terms is essential for accurate completion:
- Clinical Supervision: Oversight provided by a licensed professional over the clinical work of an applicant.
- Post-Graduate Experience: Clinical work undertaken after academic completion, vital for licensure.
- Affidavit: A written statement confirmed by oath or affirmation, used as evidence in verifying clinical experience.
Legal Use of the Affidavit
The legal considerations of using the Supervisor's Affidavit are paramount:
- Verification of Experience: Acts as a legal testimony to the acquired competencies and experience.
- Compliance: Must adhere to legal and professional standards set forth by state boards.
- Credentialing: Plays a critical role in the credentialing process, complying with ethical and legal guidelines.
Examples of Using the Affidavit
Real-world scenarios where the affidavit is utilized include:
- Social Work Licensure Applications: Mandatory submission for candidates completing their application for initial licensure.
- Career Advancement: Documents completed post-graduate experience designed to strengthen a portfolio for career progression.
Required Documents
Supporting documentation is often necessary:
- Identity Verification: Government-issued identification cards or passports.
- Certificate of Supervision: A formal document outlining the framework of supervision.
- Academic Credentials: Transcripts or degrees demonstrating educational qualifications.
Form Submission Methods
There are different ways to submit the affidavit based on preference and state requirements:
- Online Submission: Allows electronic completion and submission, reducing processing times.
- Mail Submission: Completed forms can be sent via postal services to the designated licensure board address.
- In-Person Submission: Physical delivery to the licensing authority's office, providing a personal submission touch.
By fulfilling these sections, the document successfully captures all facets of the "Documentation of Post-Graduate Clinical Experience Supervisor's Affidavit," functioning as a comprehensive verification tool for aspiring licensed social workers.
