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Please submit a copy of the license or credential with your application.
You will need to submit a proposed professional disclosure statement intended for your supervisees. If you are not currently employed in a supervisory capacity, write the disclosure statement as if you were. If the supervisory responsibilities are an aspect of your employment (e.g., counselor educator, agency worker), write the statement from that perspective. You may incorporate the required language into your agency’s PDS if needed. Your statement must address the 10 required areas listed below:
Clinical supervision training must be specific to providing clinical supervision or becoming a clinical supervisor. Reference Required Training for additional information.
You must submit an endorsement form documenting a minimum of 100 hours of your own supervised clinical supervision of individuals providing mental health services. Your supervision experience may include individual and/or group supervision, with a maximum of 10 members in a supervision group. You may use supervision of graduate students in training to fulfill this requirement. The endorser of your supervision must be a current NCC or licensed or certified mental health provider and must have training in clinical supervision.
You must document a minimum of five years of post-master’s experience in mental health services that includes at least 4,000 hours of direct service with clients. The master’s or higher degree submitted must be in a mental health field.
You may substitute a conferred doctorate and/or completed internship for up to three years and 900 hours of the total required.
Completed doctoral internship: Each school year of internship counts for one year and 300 hours of experience, or the number of hours stated in the internship course requirements.
Conferred doctorate: Each school year of enrollment in a doctoral program counts for one year and 300 hours of experience.
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