Georgia Supervised Experience Verification Forms

Which Form Goes With Which Stage

Applications for every Georgia license are filed online, through the Board's GOALS portal (board main page). The forms below are not the application itself; they are the supporting documents the Board's How-To Guides link for verifying directed experience and supervision, and every one of them asks the applicant to complete one part and hand the rest to someone else, a director or a supervisor, who signs it separately.

The counseling track (APC to LPC) and the marriage and family therapy track (AMFT to LMFT) both start with a contract affidavit, registered with (APC) or approved by (AMFT) the Board (Rule 135-5-.01(b)2; 135-5-.05(2)(c)). The social work track has no contract; a Licensed Master Social Worker is a full license on its own, not an associate credential. All three tracks end the same way, with a directed experience verification form and a separate supervision verification form.

APC to LPC: The Contract, Then Two Verification Forms

The APC Contract Affidavit, printed as the "APC Post-Master's Experience Under Direction and Supervision Contract Affidavit" (revision 2/17/2026), is required for every site and every supervisor: "You must complete a SEPARATE CONTRACT AFFIDAVIT for EACH directed experience site and supervisor." It records how the applicant is compensated at that site (W-2 employee, 1099 independent contractor, or non-compensated), the supervisor's ACS or CPCS credential number ("Required for LPC Supervisors only"), whether supervision will be delivered by technology-assisted media, and asks the supervisor to circle the type of supervision provided: "Individual Paired Group." Part V requires a weekly hour figure: "Contract affidavit must specify the number of hours per week to meet the minimum thirty-five (35) hours required per year." Supervisor eligibility for this route, including the ACS or CPCS credential, is covered in Georgia LPC supervision requirements.

LPC Form A, the Associate Professional Counselor Practicum/Internship Supervision Verification form, records the practicum or internship site, From and To dates, a total-hours figure, and a description of the practice supervised. An applicant with more than one practicum or internship submits a separate Form A for each one.

LPC Form C, the Post-Master's Directed Work Experience Verification Form, records the applicant's official job title, the agency name and address, a start date, an end date, and a "Total # of Hours" field. Its instructions are explicit about the director's role: "The Director MUST Complete Part II in its entirety and return it to the Applicant for inclusion with the Application for licensure."

LPC Form E, the Post-Master's Clinical Supervision Verification Form, is filed once per supervisor: "Complete a separate form for each Supervisor listed in your application." The supervisor returns it to the applicant "OR submit[s] directly to the Board office," and records From and To dates, a single "Total Number of Hours" field with no individual or group split, a description of the practice supervised, and a Recommend or Do Not Recommend mark. Both Form C and Form E share the same instruction on dates: "The dates must be noted on the form. 'Present' or 'Current' is not acceptable in lieu of an actual date."

LMSW to LCSW: Two Verification Forms, No Contract

A Licensed Master Social Worker is a full license, so this track carries no contract affidavit. CSW Form B, the Social Work Directed Experience Verification Form, records the agency or organization name and address, From and To dates, hours per week, and total hours. Its instructions state plainly: "(Unpaid or Volunteer experiences are NOT acceptable in meeting the directed work experience requirement)."

CSW Form C, the Social Work Supervision Verification Form, is filed once for each clinical supervisor: "Complete a separate form for each Clinical Supervisor listed in your application." Unlike LPC Form E, it splits supervision into two lines, INDIVIDUAL SUPERVISION and GROUP SUPERVISION, each with its own hours-per-week, From and To dates, and total hours, plus the supervisor's "Yrs of Experience After License Issued." Eligibility for that supervisor role, including the 120-hour supervision requirement, is covered in Georgia LCSW supervision requirements.

Form C's own instructions say what goes in with the application: the completed Form C, not a running log. "Please do not submit supervision logs unless directly requested by the Board."

AMFT to LMFT: The Contract, Then Two Verification Forms

The AMFT Contract Affidavit asks a question the counseling version does not: whether the supervisor holds a Board Approved MFT Supervisor or an AAMFT Approved Supervisor designation. Like the APC version, it requires a separate form "for each directed experience site and /or supervisor," and its instructions warn: "NO FAXED FORMS ACCEPTED." Part V of the AMFT affidavit defines supervision as "the direct, i.e., face-to-face, clinical review," a description that does not appear in the current supervision rule while the Board's FAQ allows AMFT supervision by phone, computer or video with TeleMental Health training. Hour requirements on this route, including the statutory 1,500-hour minimum, are covered in Georgia LMFT requirements.

MFT Form D, the Verification of Direct Post Graduate Clinical Experience, is filed once "for each experience listed on your Application." The applicant completes Part I; the Director of Clinical Experience completes Part II, either as an "Actual Director" or, if the original director cannot be located, a "Current Director." It records the dates and duration of the experience in total years and total months, then weekly hours split by Individual versus Couple/Family across three activities: client contact as therapist or co-therapist, case staffing or case consultation, and clinical supervision as a supervisee. Its instructions read: "Do not indicate a range of hours," and, like Form E, "NO FAXED FORMS ACCEPTED."

MFT Form E, the Verification of Supervision of Direct Post Graduate Clinical Experience, is filed once "for each Supervisor listed on your Application." It records the dates and duration of supervision, then splits the hours into "INDIVIDUAL: ___ Hours/Week," "GROUP: ___ Hours/Week," and a "TOTAL HOURS" field. The supervisor certifies one of three qualifications, AAMFT-Approved Supervisor, in supervision-of-supervision, or Georgia Board Approved MFT Supervisor, and marks Recommend or Do Not Recommend.

The Records Rule Every Track Shares

One sentence repeats across the counseling, social work and marriage and family therapy chapters of the Board's rules: "Both supervisors and supervisees are required to maintain a contemporaneous record of the date, duration, type (individual, paired, or group), and a brief summary of the pertinent activity for each supervision session to be submitted to the Board upon request. If there are any discrepancies in hours, contemporaneous documentation of supervision will be requested." (Ga. Comp. R. & Regs. 135-5-.02(a)4; the same sentence appears at 135-5-.01(a)4, 135-5-.04(2)(b)2, 135-5-.05(1)(n) and 135-5-.06(1)(o)).

Common Errors on These Forms

Related Georgia Guides

FAQ: Georgia Supervised Experience Verification Forms