Bbs Form 37A 644 – Fill Out and Use This PDF

Bbs Form 37A 644 PDF Details

Entering the world of professional counseling in California requires a detailed and structured process for licensure. The Board of Behavioral Sciences' 37A-644 form is a required document for Licensed Professional Clinical Counselors (LPCCs) pursuing licensure within the state. It was established by the California State and Consumer Services Agency to verify in-state supervised experience and confirm that applicants meet all hour requirements set by the BBS.

Both the applicant and their supervisor must complete the form carefully. The supervisor is responsible for documenting supervised hours across several required categories:

• Direct psychotherapy with individual clients
• Group therapy sessions
• Telephone counseling hours
• Client-centered advocacy (CCA) activities
• Workshops, seminars, and professional training (up to the allowable maximum)

In addition to documenting hours, the form requires verification of the applicant's employment status as an employee or volunteer. The supervisor must also confirm that the settings where experience was gained align with regulatory definitions established by the BBS. Face-to-face supervision is a key requirement, and the form includes a dedicated section for recording individual and group supervision hours provided throughout the supervised period.

The supervisor must also provide their own licensure information, including license number, type, state of licensure, and the date originally licensed. This affirms that the supervising professional holds the credentials required by California law to provide qualifying supervision for LPCC candidates. Once completed and signed by the supervisor, the form becomes part of the applicant's official licensing package submitted to the Board of Behavioral Sciences.

This procedural framework reflects California's commitment to ensuring that aspiring LPCCs are adequately prepared to serve clients in mental health settings. For applicants who need to document similar types of professional experience, FormsPal also offers the Clinical Social Experience Verification form and the Annual Supervision Verification form.