Clinical Supervisor Exemption Request - Counseling

The following submissible form can be used to request an exemption to the Clinical Supervisor requirements in A.A.C. R4-6-504 for applicants for LPC licensure.  Please read the instructions carefully.  Applicants are strongly encouraged to request an exemption prior to beginning clinical supervision with the proposed Clinical Supervisor, however the form can be submitted at any point during the supervision.  Complete all required fields, including attaching necessary documentation and click the  button.

Need to complete an additional exemption form for another supervisor?  Click here.