Get the free Verification of Supervised Clinical Work Experience Form - societyforcognitiverehab

This form is used to verify the supervised clinical work experience of applicants seeking certification in Cognitive Rehabilitation Therapy. It requires information about the applicant and their supervisor,

How to fill out verification of supervised clinical

How to fill out Verification of Supervised Clinical Work Experience Form

1. Begin by downloading the Verification of Supervised Clinical Work Experience Form from the official website or your program's portal.
2. Fill in your personal information at the top of the form, including your name, contact information, and the date.
3. Identify the clinical supervisor or supervisor’s details and provide their contact information in the designated section.
4. List the clinical settings where you completed your supervised experience, including the location and type of facility.
5. Detail the total hours you spent in supervised clinical work, specifying hours per week and the overall duration.
6. Gather signatures from your clinical supervisor confirming the accuracy of the information provided about your experience.
7. Review the form for completeness and accuracy before submission.
8. Submit the completed form to the appropriate department or regulatory agency as instructed.

Who needs Verification of Supervised Clinical Work Experience Form?

1. Individuals pursuing licensure or certification in various healthcare professions usually need the Verification of Supervised Clinical Work Experience Form.
2. Graduates from clinical training programs seeking to demonstrate their supervised practice experience to regulatory bodies or employers.

People Also Ask about

What counts as supervision for LCSW?

The clinical supervisor assumes responsibility along with the LCSWA for the assessment for treatment, diagnosis, treatment planning, clinical interventions, appropriate use of the treatment relationship, referrals, case documentation, reports, collateral contacts, termination of treatment, and all other such activity

How to calculate social work supervision hours?

Supervision typically happens once a week for an hour, so the maximum number of weekly work hours that can be counted toward a single supervision meeting is 40. Depending on your state, you may have the option of engaging with your supervisor face-to-face or remotely.

Can LCSW practice independently in Illinois?

If you move out of Illinois, please review your state's social work licensure requirements for the LSW. The Licensed Clinical Social Work (LCSW) license allows social workers to practice independently. Only experience supervised by a Licensed Clinical Social Worker will meet the professional experience requirement.

What is the new law for LCSW in Illinois?

LCSW Exam Alternative IL P.A. 103-433 Illinois Public Act 103-433, effective January 1, 2024, establishes an alternative to passing the licensing examination in order to become licensed as a licensed clinical social worker (225 ILCS 20/8.2).

How much does LCSW supervision cost?

$160/hr for licensed social workers, professional counselors and therapists.

What are the supervision requirements for LCSW in Illinois?

The Role of Clinical Supervision Clinical supervision serves several crucial functions within the field of Social Work: Guidance and Mentorship: Supervisors offer expert advice and mentorship, helping Social Workers navigate complex cases and ethical dilemmas.

What is section 1470.20 of the rules for the administration of the Illinois clinical social work and social work Practice Act?

Code . 68, § 1470.20 - Clinical Professional Experience. a) Persons applying for licensure as a licensed clinical social worker shall be required to complete supervised clinical professional experience pursuant to Section 9 of the Act and this Part.

For pdfFiller’s FAQs

What is Verification of Supervised Clinical Work Experience Form?

The Verification of Supervised Clinical Work Experience Form is a document used to confirm that an individual has completed an approved amount of supervised clinical experience as part of their training in a healthcare profession.

Who is required to file Verification of Supervised Clinical Work Experience Form?

Individuals who are seeking licensure or certification in healthcare professions are typically required to file this form to validate their clinical work experience.

How to fill out Verification of Supervised Clinical Work Experience Form?

To fill out the form, applicants must provide personal information, details of their supervised clinical experiences, including dates, settings, and supervisor signatures, along with any relevant verification documentation.

What is the purpose of Verification of Supervised Clinical Work Experience Form?

The purpose of the form is to ensure that applicants have met the necessary clinical experience requirements for licensure or certification, thereby validating their qualifications for professional practice.

What information must be reported on Verification of Supervised Clinical Work Experience Form?

The form must report information such as the name of the supervising clinician, dates of clinical experience, type of clinical settings, total hours completed, and signatures from both the applicant and the supervisor.