Marriage and Family Therapist In-State Experience Verification - California IN-STATE Experience Verification This form is to be completed by the applicant’s California supervisor and submitted by the applicant with their Application for Licensure All information on this form is subject to verification • Use separate forms for pre-degree and post-degree experience
CLINICAL SOCIAL WORKER IN-STATE Experience Verification - California IN-STATE Experience Verification This form is to be completed by the applicant’s California supervisor and submitted by the applicant with their Application for Licensure All information on this form is subject to verification o Use a separate form for each supervisor and employ ment setting
OUT OF STATE OR Out-of-Country Experience Verification Experience Verification This form must be completed by your out-of-state or out-of-country supervisor and submitted with your Application for Licensure – Path B See the Application for experience and supervisor requirements (access at www bbs ca gov> Applicant>LCSW>Forms Pubs) All information on this form is subject to verification Be
LICENSED PROFESSIONAL CLINICAL COUNSELOR EXPERIENCE VERIFICATION OUT-OF . . . OUT-OF-STATE OR OUT-OF-COUNTRY EXPERIENCE This form must be completed by your out-of-state or out-of-country supervisor and submitted with your Application for Licensure – Path B (access at www bbs ca gov> Applicant>LPCC>Forms Pubs) for experience and supervisor requirements All information on this form is subject to verification Be sure to:
OUT-OF-STATE or OUT-OF-COUNTRY Applicants - California 1 Application Selector and 7 Experience Verification (Out-of-State) Overview of Licensure Process 8 Degree Program Certification Form 2 Application Instructions (Out-of-State) 3 Application Checklist 9 Degree Program Worksheet (Out -of-Country) 4 Important Information for Applicants 10 Instructions for Live Scan
Associate Professional Clinical Counselor (APCC) Weekly Log of . . . EXPERIENCE HOURS Use a separate log for each supervisor and for each work setting Do not submit to the Board unless specifically requested Name of Associate: Last First Middle Supervisor Name Name of Work Setting Address of Work Setting BBS File No (if known): _____ APCC Number: _____ YEAR: _____ A
ASSOCIATE MARRIAGE AND FAMILY THERAPIST REGISTRATION 8 Request for Live Scan Service Form *In-State means an applicant with a degree from a school located within California, or from an online program that is designed to meet California’s requirements **Per the degree award date posted on your transcript Do NOT submit pre-degree experience hours with this application
Date: From: Telephone - California Experience hours are only allowed to be gained as an employee (where the employer issues a W-2 tax form) or as a volunteer Working as an independent contractor (where a 1099 tax form is issued) is prohibited However, there are some limited circumstances where the Board may accept hours even if theemployer issues a 1099
California Board Of Behavioral Sciences March 2022 Newsletter have signed an Experience Verification form • Establishes a new Supervision Agreement form, which must be completed for new supervisory relationships that form on or after January 1, 2022 • Changes the text required to be included in the Written Oversight Agreement for new supervisory relationships that form on or after January 1, 2022