Clinical Supervision Training Form

CLINICAL SUPERVISION TRAINING FORM

Please list the trainings you have attended and the number of hours earned from each for this credential. Attach certificates and

supporting documentation. In addition, please indicate which area(s) each training addressed, using the following codes:

1. Assessment/Evaluation

2. Counselor Development

3. Management/Administration

4. Professional Responsibilities

TRAINING EVENTS - LIST MOST RECENT FIRST

DATES

TITLE OF COURSE/

COURSE DESCRIPTION/

SPONSOR/

# CONTACT

AREA(S)

TRAINING

TRAINING GOALS

PRESENTER

HOURS

ADDRESSED

Reviewed by:____________________________

Comments: ________________________________________________

Date: _________________

_________________________________________________

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Parent category: Business