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How to use or fill out Form #2464 - Department Of Safety & Professional Services - dsps wi

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Begin by entering the NAME OF APPLICANT and the APPLICANT’S TRAINING LICENSE NUMBER in the designated fields. Ensure that all information is accurate and clearly printed.
Next, provide the NAME OF SUPERVISOR and their LICENSURE details. This includes their profession and license number, which are crucial for validation.
Indicate the beginning and ending dates of supervision. Fill in these dates accurately to reflect the duration of supervised practice.
Document the total hours of face-to-face client contact accumulated by the applicant, as well as the hours spent in supervision. This information is vital for compliance with state requirements.
In the evaluation section, check 'YES' or 'NO' for each competency area based on your assessment of the applicant's skills. Be thorough and honest in your evaluations.
Finally, ensure that both you and a notary public sign and date the affidavit at the bottom of the form to validate its authenticity.

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