SPA012 Intern plan and agreement of supervision.doc 2026

1. Click ‘Get Form’ to open the SPA012 Intern plan and agreement of supervision document in the editor.
2. Begin by entering your legal name in the 'Intern’s Name' section, ensuring you include your last name, first name, middle name, and any suffix.
3. In the 'Intern’s Texas License # and/or Social Security Number' field, provide your Texas Intern license number or your social security number as required.
4. Fill in the 'Proposed Supervisor’s Name' with their legal name, followed by their Texas license number in the next field.
5. Enter the supervisor's email address to authorize electronic communications from TDLR regarding licensing.
6. Select the applicable box indicating whether this is an initial intern license, a change of supervisor, or an additional supervisor.
7. List any other current supervisors who will no longer supervise you in the designated section.
8. Provide the employer's address where you will be supervised and specify the type of therapy sites involved.
9. Carefully read through the terms of contract section before signing and dating both intern and supervisor signatures at the bottom of the form.

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