CA BBS 37A-643 2010 free printable template

STATE OF CALIFORNIA STATE AND CONSUMER SERVICES AGENCY Governor Edmund G. Brown Jr. Board of Behavioral Sciences 1625 North Market Blvd., Suite S200, Sacramento, CA 95834 Telephone: (916) 574-7830

How to fill out bbs responsibility statement

How to fill out CA BBS 37A-643

1. Obtain the CA BBS 37A-643 form from the appropriate regulatory body or website.
2. Read the instructions carefully to understand the information required.
3. Fill in your personal information in the designated sections, including your name, address, and contact details.
4. Provide any required professional information, including your licensure details and education history.
5. Complete sections regarding your work experience and qualifications.
6. Review the form to ensure all information is accurate and complete.
7. Sign and date the form where indicated.
8. Submit the completed form according to the provided instructions, which may include mailing or online submission.

Who needs CA BBS 37A-643?

1. Individuals applying for licensure or certification in a specific field regulated by the California Board of Behavioral Sciences (BBS).
2. Professionals seeking to document their qualifications for continuing education or compliance purposes.

People Also Ask about

What is triadic supervision BBS?

Triadic supervision is defined as face-to-face supervision between one supervisor and two supervisees. Allows the 52 weeks of required individual supervision to now be either individual, triadic, or a combination of both.

How long does it take to get a social work license in Wisconsin?

Complete clinical social work experience You need at least 3,000 hours of supervised social work practice in order to apply for this license in Wisconsin, including at least 1,000 hours of face-to-face experience.

What are the supervision requirements for LMFT in CA?

California law currently requires 3,000 hours of supervised professional experience, including 104 supervised weeks, in order to qualify for LMFT licensure. o A minimum of 500 of the above hours must be gained diagnosing and treating couples, families and children.

Who can supervise an MFT trainee in California?

Mental health professionals authorized to supervise AMFTs, under California law, must maintain a current and valid license, for the following: Licensed Marriage and Family Therapist (LMFT) Licensed Clinical Social Worker (LCSW) Licensed Professional Clinical Counselor (LPCC) Licensed Educational Psychologist (LEP)

Who can supervise an MFT in California?

Mental health professionals authorized to supervise AMFTs, under California law, must maintain a current and valid license, for the following: Licensed Marriage and Family Therapist (LMFT) Licensed Clinical Social Worker (LCSW) Licensed Professional Clinical Counselor (LPCC) Licensed Educational Psychologist (LEP)

What are the new supervision requirements for BBS?

Licensees new to supervision on or after January 1, 2022 must complete 15 hours of supervision training or coursework. This course must be taken within 60 days of starting supervision. Supervisors must maintain documentation of training and/or coursework for seven years following the termination of supervision.

What is the 6 year rule for BBS?

What is the 6-year rule? The Board cannot accept hours of experience (including personal psychotherapy and workshops, training or conferences) that are older than six (6) years from the date the Board receives your Application for Licensure.

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What is CA BBS 37A-643?

CA BBS 37A-643 is a form used by licensed behavioral health professionals in California to report specific information related to their practice.

Who is required to file CA BBS 37A-643?

Licensed marriage and family therapists, licensed clinical social workers, licensed professional clinical counselors, and any other licensed mental health professionals as mandated by the California Board of Behavioral Sciences (BBS) are required to file this form.

How to fill out CA BBS 37A-643?

To fill out CA BBS 37A-643, professionals must complete sections that include their personal and licensure information, practice details, and any required disclosures as outlined in the form's instructions.

What is the purpose of CA BBS 37A-643?

The purpose of CA BBS 37A-643 is to collect data on the professional practices of behavioral health providers in California for regulatory and monitoring purposes.

What information must be reported on CA BBS 37A-643?

The form requires reporting of demographic information, licensure status, practice settings, types of services provided, and any disciplinary actions or legal issues related to the practice.