Ca form in state verification 2025

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The document is a form from the California Board of Behavioral Sciences for Licensed Professional Clinical Counselor applicants to verify their in-state experience. It requires completion by the applicant's supervisor and includes sections for supervisor and employer information, details about the applicant's experience, and verification of compliance with state regulations. The form emphasizes the importance of accurate information and outlines potential consequences for providing false details.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (192 Votes)
2015	4.4 Satisfied (327 Votes)

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