I acknowledge that I am responsible for supervising the Temporary Licensee Applicant as they complete the required 1,260 clinical work hours within an 18-month period, beginning on the date their temporary license is issued. One written extension may be requested and approved on a case-by-case basis. If the supervised experience year (SEY) is not completed within 24 months, all accrued hours will be forfeited, and the applicant must restart the SEY process.
I understand that at least 70% of the applicant’s total work hours must be devoted to clinical activities (e.g., planning for direct services, data analysis, reporting, and patient/family or professional counseling). Hours spent in administrative activities, meetings, journal groups, in-service trainings, travel, or public relations do not count toward this requirement.
I agree to provide and document regular direct supervision as follows:
Full-time applicants (30+ hours/week): A minimum of 12 hours of direct supervision must be provided every 3 months (with no fewer than 2 hours per 30-day period)
Part-time applicants (<29 hours/week): A minimum of 6 hours of direct supervision must be provided every 3 months (with no fewer than 1 hour per 30-day period). Supervision averages must be calculated in three-month segments, and inconsistent monthly hours cannot be averaged to meet this requirement. Acceptable supervision examples and additional guidance are provided by the Board.
Breaks in employment (e.g., summer breaks, medical or maternity leave, or delayed start dates) do not exempt the applicant from completing the SEY within the 24-month maximum period.
If I am unable to continue supervision, I will immediately notify the Board and submit a completed SEY Report for the period I supervised. The applicant must cease practice until a new supervision plan is submitted, approved by the Board, and a new supervisor is in place.
At the end of the SEY, I will complete the SEY Report with the applicant, ensuring all information is accurate. For online submissions, I will review and either approve or reject the hours submitted by the applicant. A tutorial for online submissions is available on the Board’s website.
I acknowledge my obligation to provide monthly direct supervision throughout the applicant’s temporary licensure period, and I understand that meeting the minimum supervision requirements does not exempt me from continuing supervision until I have formally ended the agreement with the Board.