1. Application
The application shall include:
A. Proof of the education required by Section
2 of this chapter;
B. A plan for supervision by an approved
supervisor at an agency that provides mental health services. The plan must
meet the requirements for supervised experience contained in Section
4 of this chapter and must be submitted
on a form provided by the board;
C.
A proposed disclosure statement that meets the requirements of Chapter 8-B,
Section
2(1) of the board's
rules;
D. The fee for conditional
licensure prescribed by Chapter 10, Section
5(13) of the rules of
the Office of Licensing and Registration, entitled "Establishment of License
Fees;"
E. Three letters of
reference on a form provided by the board to be completed by professionals in
the counseling field. The letters must be dated within one year prior to the
date of the application;
F. License
verifications from all jurisdictions in which the applicant was ever licensed
as a mental health professional; and
G. Such other information as the board may
require.
2.
Administrative Responsibilities and Practice Limitations
A. The temporary conditional licensee must
apply for and successfully pass the Marital and Family Therapy Examination
during the term of the license. If the temporary conditional licensee fails the
examination, the licensee is prohibited from using any clinical experience
gained during the term of the license to qualify for full licensure;
B. The temporary conditional licensee must be
employed under clinical supervision at an agency that provides mental health
services.
C. A temporary
conditional licensee shall use the designation "temporary conditional" in all
documentation, correspondence and informational materials;
D. Both the temporary conditional licensee
and the supervisor shall maintain ongoing records of supervision and shall
produce the records for inspection and copying upon request of the
board.
E. A temporary conditional
licensee may not change supervisors without prior written approval from the
board. The licensee must submit a written request explaining the reason for the
proposed change. The request must be accompanied by the termination/evaluation
report described in Section
6(2)(F) of this chapter
and a substitute supervision plan submitted on a form supplied by the
board.
F. The supervisor shall
submit a termination/evaluation report to the board upon a change of
supervisor.
3. License
Term
The temporary conditional license is issued for a term not to
exceed 6 months and may not be renewed.
4. Transition to Conditional License
The temporary conditional licensee shall be issued a
conditional license without further application or fee upon submitting proof of
a passing score on the Marital and Family Therapy Examination obtained within
the term of the temporary conditional license as described in Section
6(2)(A). The temporary
conditional license shall thereupon terminate. Supervised experience commenced
under the temporary conditional license must continue without interruption
under the conditional license.
