To be completed by supervisor with input from candidate. The form is to be submitted by supervisor. Must be submitted by July 15.

  • Part I: Identifications

  • Part II: Licenses (If Applicable)

    If you are licensed or certified as a master’s level mental health professional by a state, complete this section. Please attach a photocopy of your current license.
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  • Part III: Supervised Experience

    Each applicant must complete at least 300 hours of training and a minimum of 3 supervision sessions. The supervised experience must be current and cannot be more than four years from the date of application for certification. Supervision sessions provided by Non-TEPs must be approved in advance by the primary trainer.
  • Trainer NameTrainer NameTrainer NameTrainer Name 
  • Part IV: Application Attestment: Supervisor MUST confirm the following statements:

    My primary trainer and I have carefully read and reviewed this SP Application Form and all supporting documents and attest to the accuracy of these documents. I understand it is my responsibility to deliver the SP Application and supporting documents directly to the Board.
  • Part V: Upload Endorsement Form

  • Please upload your exam files below. They must be in .doc, .docx, or .pdf format.
  • Accepted file types: doc, docx, pdf, Max. file size: 128 MB.
    Please attach the endorsement letter confirming your supervision of the candidate.
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