List the name of the candidate applying for approval of the Supervision Agreement Form.
Supervision Agreement
In order to begin the accrual of supervised experience hours the Board must confirm the candidate for licensure has a completed application on file, a passing result on the jurisprudence exam, and a passing result on the national exam. In addition the candidate must also submit a W-4 confirming their status as an employee of the agency where they intend to accrue supervised experience and a completed Supervision Agreement.
Supervised experience may commence as of the approved date on the Supervision Agreement. Any hours accrued prior to the approval date on the Supervision Agreement will not be credited towards your supervised experience requirements and may result in the initiation of formal complaint procedures and/or loss of approved supervisor status.
You may submit your completed Supervision Agreement and W-4 in the Applicant Portal by logging into your portal account.
Form Instructions
Please Note: You must verify your employee status by submitting a W-4 for the location in which you are requesting to receive supervised experience hours, and the W-4 must be submitted with the Supervision Agreement Form.
Please refer below for hints on how to fill each of the form fields on the Supervised Agreement form.