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1 Month/Year _____Supervisee's Signature_____ ALPS's Signature _____Daily/Weekly Log Sheet for a Supervised CounselorDaily/Weekly Log Sheet for a Supervised CounselorDateIndividuCounselial ngGrouCounsep lingFamCounily selingConsultationCounseling RelatedScreening/ AssessmentIntake/ diagnosticCrisIntervenis tionCase.
Licensed Professional Counselor (LPC) as of December 1, 2017 Board Meeting Last Name First Name Business Address City Business Address State Status of License
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