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Request for Supervised Practice Form

The Board of Professional Counseling (“the Board”) uses this form to consider whether to allow an applicant the ability to work for 120 days while a completed application with required documents is being processed. For a list of all required documents, please see the application check lists. Applicants cannot begin work without Board approval.
An approval will not be granted if the following exists:
  1. No application on file with the Board;
  2. No FBI criminal background result;
  3. Positive criminal background result(s);
  4. Termination from employment is reported; and/or
  5. Prior disciplinary action by a licensure board in any state/jurisdiction is found.
  6. Education Requirements not met;
  7. No vaccination or No Exemption approval Letter from DC Health.
If the supervised practice form is approved, the allowance is only for work with the supervisor approved at the location identified on the form. The allowance is a one-time issuance good for 120 days from the date of approval.