Supervision Agreement
Clinical Supervision Agreement
Review the complete Clinical Supervision Agreement below, then complete and sign it electronically.
Important Notice
This supervision agreement is provided for informational review. Click "Complete & Sign Agreement" above to fill in your details and sign electronically. It is the sole responsibility of the supervisee to determine if the supervisor's license, training credentials, and method of supervision delivery meet the requirements for clinical supervision in the state where you are seeking licensure.
Your Clinical Supervisor
Full Name
Arisza Hillman, LCSW
Credentials
MSW, CFSW
Supervisory Credentials
LCSW-S
Licensure States
Virginia, Texas, New York, Maryland
Contact Number
757-319-5174
Contact Email
Agreement Sections
Supervisor:
Arisza Hillman, LCSW, BCD
Select a state above to populate license info
Contact: 757-319-5174 | [email protected]
Supervisee:
Your name will appear here
Email: [email protected]
SUPERVISOR INFORMATION
| Full Name: | Arisza Hillman, LCSW |
| Credentials: | MSW, CFSW |
| Supervisory Credentials: | LCSW-S |
| Licensure State: | ___________ |
| License Number: | ___________ |
| Contact Number: | 757-319-5174 |
| Contact Email: | [email protected] |
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date specified.
Arisza Hillman, LCSW, BCD
Clinical Supervisor Signature & Date
[Supervisee Name]
Supervisee Signature & Date
Related Documents
Download the supervision agreement template and other related forms for your records.
Ready to Sign?
Complete your information and sign the Clinical Supervision Agreement electronically right here.