CPCS Supervision Forms 


 Supervision Forms

Why use the Industry Standardized Supervision forms?  License Law and board rules

  • We have seen a 60% increase in supervision audits at the Licensing Board due to supervision paperwork discrepancies.
  • As a result,  there have been “denials” of their application
  • Applicants have had to testify (justify) at a Composite Board hearing; supervision. 
  • The CPCS Committee and a host of others worked to identify the issues and help provide a working solution.

Using the new Industry Standardized Supervision forms (correctly filled out) can minimize the chance of application denials, saving both supervisors and supervisees valuable time and money!!!

SUPERVISION FORMS:  Click on the titles below to download the pdf/xlsx forms.  LPCA members who would like the forms in MS Word Docx (that is the newer version of Word) See below under the CPCS Supervisor Resources.

Summary of Supervision Hours Individual Summary of Supervision Hours
Supervision Notes "the Logs"

Supervision Notes "the Logs"


Non-Clinical Supervision Notes Directed Experience Log  click here


The Clinical Supervision Toolkit  Click Here 

To order a printed Booklet Copy of the Clinical Supervision Toolkit  Click Here

CPCS Supervisor Resources

Adaptive Solutions (6)
Case Acuity (7)
Centering Exercise (10)
Clinical Scenarios GA
Clinical Skills Self Inventory

Ethical Decision Process Worksheet
Ethics in Supervision
Holding Environment
Models of Decision Making
Possible Self-As an Exercise (8)
Qualitative Supervision Evaluation

No Right to Private Practice Agreement

The Supervisory Relationship Questionnaire SRQ

Sample Contract  PDF

Sample Contract Word Doc.

Word Documents of the Supervision Forms:

Supervisor Summary of Supervision Hours

Supervisor Notes "the Logs"

Supervisor Non-Clinical Supervision Notes

Supervisee Individual Summary of Supervision Hours

Supervisee Notes "the Logs"

Directed Experience Log


How to Explain the Licensing Process

Flowchart for the Licensure Process

What are you missing in your licensure process?


The Licensure Process From the Ground Up


 Complaint About a Supervisor?  CLICK HERE