What is the purpose of the 37A 301A form?
The 37A 301A form is used to verify the in-state experience of applicants seeking licensure as Licensed Marriage and Family Therapists in California. This form must be completed by the applicant’s California supervisor and submitted with the application for licensure and examination.
Who should complete the 37A 301A form?
The form must be completed by the applicant's California supervisor. This ensures accurate reporting of the applicant's supervised experience, which is necessary for obtaining licensure.
What information is required from the supervisor?
The supervisor must provide their name, contact information, license type, and license number. Additionally, they must confirm whether the applicant has received supervision that meets California law requirements during the entire period of supervision.
Are there different versions of the form for pre-degree and post-degree experience?
Yes, separate forms should be used for reporting pre-degree and post-degree experience. This helps differentiate between the applicant’s training stages and ensures clarity in documentation.
What is the significance of the 'Original Signature' requirement?
An original signature ensures the authenticity of the information provided on the form. Supervisors must also initial any changes made to maintain integrity and transparency in the reporting process.
Are applicants required to submit additional documents with the form?
Yes, if the applicant was paid during their internship, they must attach a copy of their W-2 statement for each year of claimed experience. If no W-2 has been issued yet, a current pay stub should be included. For voluntary positions, a verification letter from the employer is required.
What happens if false information is provided on the 37A 301A form?
Providing false information or omitting significant details can lead to the denial of the licensure application. Moreover, the Board may take disciplinary action against any licensee involved in fraudulent practices concerning the application.
How many hours of experience must be claimed for licensure?
Applicants must log a minimum of 1,750 hours of direct counseling experience, which includes at least 500 hours of diagnosing and treating couples, families, and children. Up to 1,250 hours may be claimed for non-clinical experience.
What types of settings qualify for experience verification?
Experience must be gained in settings that lawfully and regularly provide mental health counseling. Oversight to ensure compliance with supervision requirements and the scope of practice is also essential for the experience to be valid.
How should the completed form be submitted?
The completed 37A 301A form should be submitted along with the applicant's Application for Licensure and Examination. Ensuring that all required information is accurate and that the form is signed is crucial for the success of the application process.