Board Of Behavioral Sciences - Marriage And Family Therapist Trainee / Intern Weekly Summary Of Hours Of Experience

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STATE OF CALIFORNIA – BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY
Governor Edmund G. Brown Jr.
Board of Behavioral Sciences
1625 North Market Blvd., Suite S200, Sacramento, CA 95834
Telephone: (916) 574-7830
TTY: (800) 326-2297
MARRIAGE AND FAMILY THERAPIST TRAINEE / INTERN
WEEKLY SUMMARY OF HOURS OF EXPERIENCE
OPTION 1 – NEW STREAMLINED METHOD
Name of Trainee/Intern:
Last
First
Middle
Supervisor Name
Date enrolled in graduate degree program
Name of Work Setting
Address of Work Setting
(use a separate log for each)
Indicate your status when the hours below are logged:
Trainee
Post-Degree / Intern Application Pending - BBS File No (if known): ________________
Registered Intern - MFT Intern Number: _______________
Total
YEAR __________
WEEK OF:
Hours
A. Direct Counseling with Individuals,
Groups, Couples or Families
A1. Diagnosis and Treatment of Couples,
Families, Children*
B. Non-Clinical Experience**
B1. Supervision, Individual*
B2. Supervision, Group*
C. Total Hours Per Week
(A + B = C) (Maximum 40 hours / week)
* Line A1 is a sub-category of “A” and Lines B1 and B2 are subcategories of “B.” When totaling weekly
hours do NOT include the subcategories - use the formula found in box “C.”
**Non-Clinical Experience includes: Supervision, psychological testing, writing clinical reports, writing
progress or process notes, client-centered advocacy, and workshops, seminars, training sessions or
conferences.
37A-525 (Revised 05/2016)

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