Okla. Admin. Code § 86:20-3-2

Current through Vol. 42, No. 8, January 2, 2025

Section 86:20-3-2 - Description of forms

(a) The Application Form requires the following:

(1) Identifying information of applicant;

(2) Possession of other credentials;

(3) Previous misconduct;

(4) Education;

(5) References; and

(6) Proposed professional Practice.

(b) The Internship/Practicum Documentation Form requires the following:

(1) Identifying information of applicant;

(2) Place, time, duration and nature of supervised experience;

(3) School arranging supervision and name of supervisor; and,

(4) Signature and title of supervisor.

(c) The Supervision Agreement requires identifying information of supervisee and supervisor as follows:

(1) Name of candidate;

(2) Name of candidate's place of employment;

(3) Location supervised experience hours are being accrued;

(4) Candidate's contact information;

(5) Signature of Candidate;

(6) Name of Approved LBP Supervisor;

(7) Name of Approved LBP Supervisor's place of employment;

(8) LBP Approved Supervisor's contact information;

(9) Signature of LBP Approved Supervisor;

(10) Name of On-Site Supervisor;

(11) On-Site Supervisor's licensure information;

(12) Name of On-Site Supervisor's place of employment;

(13) On-Site Supervisor's contact information;

(14) Signature of On-Site Supervisor.

(d) The Evaluation of Supervised Experience Form requires the following:

(1) Names of supervisee and supervisor;

(2) Name and location of supervision site;

(3) Duration of work experience and supervision;

(4) Types of professional activities and clients seen;

(5) Rating of quality of professional activities;

(6) Supervisor and supervisee comments; and

(7) Signatures of supervisee and supervisor.

(e) The Verification of Academic Standing requires the following information:

(1) Name of applicant;

(2) Name of university;

(3) Name of graduate program;

(4) Name of degree;

(5) Total number of graduate coursework hours required to receive diploma;

(6) Date of graduation;

(7) Signature and signature date of applicant;

(8) Name of administrator and/or school official;

(9) Title/position of administrator and/or school official;

(10) Telephone number of administrator and/or school official;

(11) Email address of administrator and/or school official;

(12) Signature and signature date of administrator and/or school official.

Okla. Admin. Code § 86:20-3-2

Adopted by Oklahoma Register, Volume 32, Issue 24, September 1, 2015, eff. 9/11/2015

Amended by Oklahoma Register, Volume 33, Issue 24, September 1, 2016, eff. 9/11/2016

Amended by Oklahoma Register, Volume 36, Issue 21, July 15, 2019, eff. 7/25/2019

Amended by Oklahoma Register, Volume 40, Issue 22, August 1, 2023, eff. 8/11/2023

Amended by Oklahoma Register, Volume 41, Issue 21, July 15, 2024, eff. 7/25/2024