Transcription of Documentation of Supervised Counseling Experience
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Documentation of Supervised Counseling Experience
New Jersey Office of the Attorney GeneralDivision of Consumer AffairsState Board of Marriage and Family Therapy ExaminersProfessional Counselor Examiners Committee124 Halsey Street, 6th Floor, Box 45044 Newark, New Jersey 07101(973) 504-6582 Documentation of Supervised Counseling Experience (This form should be completed by the supervisor and forwarded directly to the Committee.)Information about the applicant_____ Last name First name Middle initial Maiden name (if applicable) _____ Street address City State ZIP code_____ _____ Telephone number (include area code) E-mail address Information about the supervisor_____ Last name First name Middle initial Maiden name (if applicable) _____ Street address City State ZIP code_____ _____ Telephone number (include area code) E-mail
New Jersey Office of the Attorney General ... Documentation of Supervised Counseling Experience ... The supervisor must hold a clinical license in a …
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