Who fills out the BBS Experience Verification form?

Your supervisor completes and signs it; you send it to the Board with your Application for Licensure.

Do I need a separate Experience Verification form for each supervisor?

Yes. The forms ask for a separate form for each supervisor and each employment setting, and for LMFT, separate forms for pre-degree and post-degree hours.

Can my supervisor sign the Experience Verification electronically?

The current forms say an original or electronic signature is required, and the LCSW form also accepts a scanned signature.

Do I send my weekly logs with the Experience Verification form?

No, not unless the Board asks for them. Keep them as your record.

California · AMFT, APCC and ASW

The BBS Experience Verification form, explained

The Experience Verification form is how your hours reach the Board of Behavioral Sciences. Your supervisor fills it in from your weekly logs and signs it, and you send it with your Application for Licensure. This page explains the form for LMFT, LPCC and LCSW: which one you need, what each section asks, and what to check before your supervisor signs. It is our summary of the Board's forms as we read them on October 23, 2026.

A reference, not legal or licensing advice. Confirm is not affiliated with the California Board of Behavioral Sciences and does not speak for it. We summarize the Board's published requirements as a convenience and they can change or be read differently, so this page may be incomplete or out of date. The Board has the final say: always confirm your requirements with the Board and your supervisor. Use this page at your own risk. See the Terms.

Which form

License	Form
LMFT (AMFT and trainee hours)	Marriage and Family Therapist In-State Experience Verification, BBS 37A-301
LPCC (APCC hours)	Professional Clinical Counselor In-State Experience Verification, BBS 37A-675
LCSW (ASW hours)	Clinical Social Worker In-State Experience Verification, BBS 37A-201

These are for hours earned in California. Hours from another State go on the Board's out-of-state verification forms instead.

How many you need

One per supervisor, per employment settingTwo supervisors at one site is two forms. One supervisor at two sites is also two forms.
LMFT: separate forms before and after your degreeTrainee (pre-degree) hours and associate (post-degree) hours never share a form, and the LMFT form has a box to mark which it is.
Who fills it inYour supervisor completes and signs it. You collect the forms and send them with your application.

What each section asks

ApplicantYour name, your associate number and the dates of the experience on this form.
SupervisorName, email, business phone, license type and number, and the date they were first licensed. If they had been licensed in California for less than two years on the first date you claim, they attach their out-of-state license information. A psychiatrist supervisor also answers a question about board certification.
EmploymentWhether your supervisor was employed by your employer. If not, whether they and your employer signed a written agreement about overseeing you; if so, you send a copy of that agreement.
Your employerThe employer's name, phone and address, and whether the setting was a private practice or professional corporation.
PayWhether you were paid. If yes, you send a W-2 for each year claimed (or a current paystub if this year's W-2 isn't out yet). If you volunteered, you send a letter from the employer confirming it. On the LMFT form this applies to associate hours only.
ExperienceThe dates, the number of supervised weeks, and the hours: total clinical hours and total non-clinical hours, and how much of the non-clinical time was individual or triadic supervision and group supervision.
SignatureYour supervisor signs and dates it. The forms accept an original or electronic signature (the LCSW form also says scanned).

The hours lines, by license

	LMFT	LPCC	LCSW
Clinical hours	Total direct clinical counseling	Total direct clinical counseling	Total clinical psychosocial diagnosis, assessment and treatment
Of those	Hours diagnosing and treating couples, families and children	None	Hours of face-to-face individual or group psychotherapy
Non-clinical hours	Total non-clinical experience	Total non-clinical experience	Client-centered advocacy, consultation, evaluation, research, workshops, trainings and direct supervisor contact
Of those	Individual or triadic supervision, and group supervision

These are the same buckets as lines A and B on the weekly log, totalled for the whole period with this supervisor at this setting.

Check these before your supervisor signs

The totals match your weekly logsAdd up the logs for this supervisor and setting and compare. The Board can ask for the logs.
The form is completeThe forms ask for this before signing, and any change after that needs your supervisor's initials.
The supervisor's first-licensed dateThe Board credits supervision only from someone licensed at least two years, so this date matters.
The paperwork that goes with itW-2s or a volunteer letter, and a written agreement if your supervisor wasn't employed by your employer.
LCSW: who supervised whatAt least 1,700 of an ASW's hours, and 13 weeks with an hour of individual or triadic supervision, must be under an LCSW. Your forms are how the Board sees that split.
Get it signed when supervision endsNot years later. Supervisors move, retire and change email addresses.

How Confirm fills it in for you

One form per supervisor and site, from your logConfirm totals your weeks and hours into the right lines, including the couples, families and children hours (AMFT) and psychotherapy hours (ASW).
Your supervisor reviews and signs onlineThey get a link, check the numbers and sign from their phone, free. The signed form comes back as a PDF with a signature certificate.
The checks run all alongConfirm flags weeks without enough supervision, supervision before a supervisor's two-year date, and for ASWs the hours still needed under an LCSW.

Questions people ask

Who fills out the BBS Experience Verification form?Your supervisor completes and signs it; you send it to the Board with your Application for Licensure.
Do I need a separate Experience Verification form for each supervisor?Yes. The forms ask for a separate form for each supervisor and each employment setting, and for LMFT, separate forms for pre-degree and post-degree hours.
Can my supervisor sign the Experience Verification electronically?The current forms say an original or electronic signature is required, and the LCSW form also accepts a scanned signature.
Do I send my weekly logs with the Experience Verification form?No, not unless the Board asks for them. Keep them as your record.

Sources

Read on October 23, 2026. This summary may be incomplete or out of date. The Board's own forms, statutes, regulations and handbooks are the only authority; confirm your requirements with the Board before you apply.