Washington State Forms
for the
Supervision of
Therapists and Counselors
Pre-license Reporting Forms for
Licensed Mental Health Counselor Associates,
Licensed Independent Clinical Social Worker Associates and
Licensed Marriage and Family
Therapist Associates
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Forms Used by the Supervising Counselor
(and given to each counselor being supervised)
Approved Supervisor Licensed Mental Health Counselor (Form DOH 670-090,
1/2007) Please review: WAC 246-809-234
Approved Supervisor Licensed Social Worker (Form DOH 670-091--2/2007)
Please review: WAC 246-809-334
Approved Supervisor Licensed Marriage and Family Therapist (Form DOH 670-092, 4/2007)
Please review: WAC 246-809-134
Approved Supervisor for Certified Counselor. The
form is at the end of the application packet.
Approved Supervisor for Certified Advisor.
The form is near the end of the application packet (page 14 of 16).
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Forms Used by the Counselor to Report
Hours of Supervision to the State of Washington
"
Mental Health Counselor Associate Supervision and Experience Verification" Form. (one form for each supervisor)
" Marriage
and Family Therapy Supervision and Experience Verification" form. (one form for each supervisor)
"
Verification of Social Worker Supervised Postgraduate Experience" form. (one form for each supervisor)
If any of these state links are broken--don't be surprised. On the Washington
State's website, URL addresses frequently are changed when the content is
changed. In that case (1.)
please notify Counseling Washington about broken links so we can update them, and
(2.) follow the directions below that were kindly furnished in
May 2007, by Dawn Thompson, Program Representative, Health Professions Quality
Assurance Washington State Department of Health:
"The Approved Supervisor forms are
located with the forms and applications that pertain to the correlating
licensures....You can download these forms by going to
www.doh.wa.gov click on Topics A-Z and choose the first letter of the licensure
you need. Once you have that licensure pulled up there will be a site directory on
the left hand side. Click on 'forms and applications', then click on approved
supervisor form, down load and print...."
With Counseling Washington's
counselor locator service, counselors can be located by name, geographic area, or niche specialty.
The mental health and
addictions counselors listed on these pages are:
(1.) Licensed Psychologists
(2.) Licensed Mental Health Counselors (LMHC),
(3.) Licensed Marriage and Family Therapists (LMFT),
(4.) Licensed Mental Health Counselor Associates (LMHCA),
(5.) Licensed Marriage and Family Therapist Associates (LMFTA),
(6.) Licensed Independent Clinical Social Workers (LICSW),
(7.) Licensed Social Work Associate-Advanced (LSWAA)
(8.) Licensed Social Work Associate—Independent Clinical (LSWAIC), and
(9.) Masters-level Certified Counselors (CC).
If the viewer has information that any professionals on this site are misrepresenting their qualifications,
please let us know.
To Top--Washington
State forms used in Clinical Supervision of Counselors
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