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Form #2464 - Department Of Safety & Professional Services - dsps wi-2026
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How to use or fill out Form #2464 - Department Of Safety & Professional Services - dsps wi
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- Click ‘Get Form’ to open it in the editor.
- 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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