Client Contact And Supervision Hours
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1
2New Jersey Office of the Attorney General
Division of Consumer Affairs
State Board of Marriage and Family Therapy Examiners
124 Halsey Street, 6th Floor, P.O. Box 45007
Newark, New Jersey 07101
(973) 504-6415
Client Contact and Supervision Hours
This form allows for six (6) sets of hours reporting.
Work
Client Contact Hours
Supervision
Related
Work
Relational
Type
Dates
Supervision
Couple
Family
Individuals
Related
(add couple
of
Total
(Month/Year)
Hours
(relational)
(relational)
Hours
& family hrs.)
Supervision
Individual
Group
Work
Relational
Type
Dates
Couple
Family
Supervision
Individuals
Related
(add couple
of
Total
(Month/Year)
(relational)
(relational)
Hours
Hours
& family hrs.)
Supervision
Individual
Group
Work
Relational
Type
Dates
Supervision
Couple
Family
Individuals
Related
(add couple
of
Total
(Month/Year)
Hours
(relational)
(relational)
Hours
& family hrs.)
Supervision
Individual
Group
Relational
Work
Type
Dates
Couple
Family
Supervision
Individuals
(add couple
Related
of
Total
(Month/Year)
(relational)
(relational)
Hours
& family hrs.)
Hours
Supervision
Individual
Group
Work
Relational
Type
Dates
Family
Supervision
Couple
Individuals
Related
(add couple
of
Total
(Month/Year)
(relational)
Hours
(relational)
Hours
& family hrs.)
Supervision
Individual
Group
Work
Relational
Type
Dates
Couple
Family
Supervision
Individuals
(add couple
Related
of
Total
(Month/Year)
(relational)
(relational)
Hours
& family hrs.)
Hours
Supervision
Individual
Group
Cumulative
Total:
(Add total
hours down)
Ratio of Supervision to Client Contact (1:5) = (Should equal .20 or greater. Divide total supervision hours by total
client contact hours; individual supervision is 1 or 2 supervisees; group supervision is 3 to 6 supervisees.)
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