One Form, Three Tracks
DH-MQA 1181, titled "Verification of Clinical Experience," is revised 5/2025, one page, and fully fillable. The Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling adopts it by rule 64B4-3.0015, and the same form serves all three of its registered-intern tracks: Registered Mental Health Counselor Intern (RMHCI), Registered Marriage and Family Therapy Intern (RMFTI), and Registered Clinical Social Worker Intern (RCSWI). Near the top of the form, the applicant checks a box for which of the three professions applies rather than downloading a separate version per track.
The form itself quotes the rule it exists to document: an intern is credited for supervision if they received at least 100 hours of supervision in no less than 100 weeks, provided at least 1,500 hours of face-to-face psychotherapy with clients, and received at least one hour of supervision every two weeks. The form's two hour fields record the totals behind those conditions.
The Supervisor Signs It, Per Supervisor, Within 7 Days
The form is completed and signed by the supervisor, not the intern. Each DH-MQA 1181 covers one supervisor, so an intern who worked under three qualified supervisors over the course of a registration needs three separate, completed forms, each carrying that supervisor's own hour totals for the period they supervised.
The supervisor submits the completed form to the Board within 7 days after that supervision relationship ends, either by email to MQA.491@flhealth.gov or by mail (64B4-2.0025(5)(g)). The form itself lists the Board's mailing address for that filing. That 7-day clock runs from the end of the relationship with that specific supervisor, not from the end of the intern's whole registration.
What the Form Asks For
The form runs in three parts: supervisor information, the supervised clinical experience itself, and a supervisor statement.
| Field | What It Collects |
|---|---|
| Applicant name and registration number | Intern's name and Florida intern registration number, or another state's license number |
| Profession checkbox | Clinical Social Work, Marriage & Family Therapy, or Mental Health Counseling |
| Supervisor information | Name, email address, license type, state and license number |
| Dates of supervision | Start date and end date for that supervision relationship |
| Hours of supervision | Total supervision hours for that relationship, with an acknowledgment of the at-least-one-hour-every-two-weeks rate |
| Face-to-face hours | Total hours of psychotherapy face-to-face with clients for that relationship |
| Intend / no-longer-supervising toggle | Either an intent to keep supervising until full licensure, or a stopped date if supervision has ended |
| Supervisor signature and date | A plain blank signature line, not a fillable field, plus a form signature date |
What the Form Does Not Collect
The form has exactly two hour fields, and nothing beyond them. It does not split face-to-face hours into a direct and indirect category the way some other states' forms do.
For the LMFT track specifically, the form does not capture the 50 percent MFT-services rule. Florida law requires that 50 percent of an RMFTI's clients be receiving marriage and family therapy services during the 2 years of clinical experience (s. 491.005(3)(d), F.S.), but the DH-MQA 1181 has no couples or family split field and no way to record that ratio. The single face-to-face total is the same field used by all three tracks.
For the frequency and alternation rules that govern how those supervision hours accrue in the first place, see Florida registered intern supervision requirements.
One Form Per Supervisor, Inside One Licensure Application
The full licensure application, Form DH-MQA 1174, needs one completed DH-MQA 1181 from every qualified supervisor an intern worked under, not a single combined form for the whole registration. The totals across every 1181 in the file need to add up to the 1,500 face-to-face hours and 100 supervision hours the rule requires. The first filing in the whole process, long before any 1181, is the registered intern application.
Two Supervisors, Two Forms, One Total
An intern spends the first stretch of their registration under Supervisor A, then changes jobs and finishes under Supervisor B. Supervisor A's DH-MQA 1181 lists 900 face-to-face hours and 65 supervision hours for that period. Supervisor B's DH-MQA 1181 lists 600 face-to-face hours and 35 supervision hours for the remainder.
Added together, the two forms carry 1,500 face-to-face hours (900 + 600) and 100 supervision hours (65 + 35), reconciling exactly to the totals the rule requires (64B4-2.001(1)(a); 64B4-2.002(1)(a)). Neither form alone shows a complete file; the licensure application relies on both totals summing correctly.
Keep Per-Supervisor Totals From Day One
Since each DH-MQA 1181 needs its own supervisor-specific totals and dates, it helps to keep those two numbers, supervision hours and face-to-face hours, and the start and end dates, current for each supervisor as the weeks pass. It saves reconstructing them once a relationship ends.
The supervisor is also required to keep their own record: Form DH-MQA 5078, "Supervision Log" (5/2023), which the supervisor must give the intern access to (64B4-2.0025(5)(e)). An intern's own running numbers and the supervisor's log are two separate records of the same relationship, and having both makes the eventual DH-MQA 1181 a matter of copying numbers down rather than reconstructing a history.
Common Mistakes on the DH-MQA 1181
Waiting until the whole registration ends to think about the form
Each 1181 closes out one supervisor relationship, due within 7 days after that relationship ends, not after the whole registration is over. A supervisor who left a job two years ago may be harder to reach for a signature today.
Filing one form for multiple supervisors
The form covers a single supervisor's totals and dates. Multiple supervisors mean multiple forms, each signed by the supervisor it names.
Assuming the MFT 50 percent rule shows up somewhere on the form
It does not. The form's one face-to-face hours field is the same for every track, with no couples or family split, even though the underlying MFT statute requires that composition separately.
Letting the totals across supervisors fall short of 1,500 and 100
The 1,500 face-to-face and 100 supervision totals have to add up across every 1181 in the file. No single form carries the full total.
Keep Your Numbers Ready for Every Supervisor
HourJourney gives you a place to keep the numbers straight from your first logged week:
- ✓Log hours by week
- ✓Running totals kept per supervisor
- ✓Running totals by category
- ✓An export history
Built for pre-licensed clinicians.
Related Florida Guides
Florida LMHC Requirements
The full RMHCI-to-LMHC path, with every hour and rule cited.
Florida LCSW Requirements
The full RCSWI-to-LCSW path, including the coursework carve-outs.
What Is an RMHCI in Florida
The registration itself: title, scope, and how it leads to the LMHC.
What Is an RCSWI in Florida
The registration itself for the clinical social work track.
Florida Registered Intern Supervision Requirements
Frequency, delivery mode, and the alternation rule in full.
The Registered Intern Application
Filing DH-MQA 1175 for any of the Board's three intern tracks.
FAQ: DH-MQA 1181 Verification of Clinical Experience
What is the DH-MQA 1181 form?▾
DH-MQA 1181, "Verification of Clinical Experience," is the form Florida's Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling uses to confirm a registered intern's supervised hours. It is revised 5/2025, one page, and a fully fillable PDF. The same form covers all three registered-intern tracks: RMHCI, RMFTI and RCSWI. It is adopted by rule 64B4-3.0015.
Who fills out the DH-MQA 1181?▾
The supervisor does, not the intern. One form covers one supervisor. An intern who worked under more than one qualified supervisor over the course of their registration needs one completed and signed DH-MQA 1181 from each of them, each with its own hour totals for that specific supervision relationship.
When is the DH-MQA 1181 due?▾
The supervisor submits it to the Board within 7 days after that supervision relationship ends, by email to MQA.491@flhealth.gov or by mail (64B4-2.0025(5)(g)). It is not filed while supervision is ongoing; it closes out a specific supervisor relationship once that relationship is over.
What does the DH-MQA 1181 collect?▾
Two hour totals for the supervision period: total hours of supervision and total hours of face-to-face psychotherapy. It also collects the applicant's name and intern registration number, a profession checkbox, the supervisor's name, email, license type, state and license number, the supervision start and end dates, and either an intent-to-continue selection or a no-longer-supervising date. The signature line is a plain blank, not a fillable field.
Does the DH-MQA 1181 capture the MFT 50% rule?▾
No. Florida law requires that 50 percent of an RMFTI's clients be receiving marriage and family therapy services during the 2 years of clinical experience (s. 491.005(3)(d), F.S.), but the DH-MQA 1181 has no field for it. The form collects one undifferentiated face-to-face total for every track, with no couples or family split.
How many DH-MQA 1181 forms does a Florida registered intern need?▾
One per supervisor, not one per year or one for the whole registration. The full licensure application, Form DH-MQA 1174, needs a completed DH-MQA 1181 from every qualified supervisor the intern worked under, and those forms' totals need to add up to the 1,500 face-to-face hours and 100 supervision hours the rule requires.
Where do I find the DH-MQA 1181?▾
The Board hosts the current version as a PDF at floridasmentalhealthprofessions.gov. It is the same file for RMHCI, RMFTI and RCSWI interns; the applicant selects their profession on the form itself rather than downloading a track-specific version.
More Florida guides
For the Board's three registered-intern tracks and the rest of the cluster, see all Florida guides.
Requirements verified against Chapter 491, F.S. and Rule Chapter 64B4, F.A.C., as adopted by the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling and current as of September 2026. Statutes, rules and forms can change. Always confirm the current DH-MQA 1181 form and its requirements at floridasmentalhealthprofessions.gov before making decisions about your licensure path. This guide is for informational purposes only and does not constitute legal or professional advice.