Michigan Counseling Work Experience Form: What It Asks and When

The Counseling Work Experience Form

LARA's Bureau of Professional Licensing calls this document by one printed title, "Counseling Work Experience" (LARA/BPL-COUNSELEXP, 4/25). The form runs one page and is fillable, and the totals it certifies are the ones the Michigan Board of Counseling rules set. When more than one person has supervised the applicant, the form is direct about how many copies exist: "A separate form must be completed by each supervisor."

The applicant fills the top section: name, date of birth, telephone number, and LLPC license number. Everything below that line belongs to the supervisor. Each supervisor names their agency, gives its address, and certifies that they "practiced counseling under my supervision from ___ to ___ for a total of ___ hours including ___ hours in my immediate physical presence or via 2-way real-time audiovisual technology." The supervisor also certifies the training required under R 338.1781, certifies they were "available on a regularly scheduled basis to review the practice of the applicant, to provide consultation, to review records, to further educate the applicant and there was continuous availability of direct communication in person or by radio, telephone or telecommunication," signs, and lists their license number. A supervisor licensed outside Michigan lists their state and license type instead.

What the Form Actually Tracks

Strip away the certifications and the form is asking for two numbers and a date range: a total hours figure and a supervision hours figure, over a period the supervisor writes in by hand. There is no category breakdown and no month-by-month record built into it. That means the limited licensee is the one keeping the split between total hours and supervision hours themselves, starting the day the LLPC issues, since nothing on this form reconstructs that split later.

One Form per Supervisor

An LLPC who changes agencies, or who works under more than one Michigan LPC over the course of accruing hours, needs one Counseling Work Experience form for every supervisor who signed off on hours, not one form covering all of them. The rule also places a documentation duty on the supervisor's side of the relationship: a licensee who provides counseling supervision "shall keep ongoing documentation including, but not limited to, performance and clinical notes, for each supervisee" (R 338.1781(4)). That record lives with the supervisor, separate from whatever the applicant tracks.

Where the Form Goes

LARA's guide places the form with the rest of the LPC application: "Completed Counseling Work Experience form submitted to this office" alongside the application package. The guide does not say whether the applicant or the supervisor is the one who sends it in, so this page will not guess either. Whoever handles it, the destination is the same office that receives the transcripts, exam score, and professional disclosure statement that round out the LPC file.

The Hours the Form Has to Add Up To

A supervisor's certified hours have to reconcile with the totals the rule sets. A master's-level LLPC needs "not less than 3,000 hours accrued in not less than a 2-year period, with not less than 100 hours of regularly scheduled supervision" (R 338.1774(1)(c)(i)). A doctoral-level LLPC needs "not less than 1,500 hours accrued over not less than a 1-year period, with not less than 50 hours" of supervision (R 338.1774(1)(c)(ii)). Whichever path applies, the form's total-hours and supervision-hours fields are where those figures are certified.

The 10-Year Limit on the LLPC License

The LLPC license that makes those hours possible does not run indefinitely. It "may be renewed annually, but for no more than 10 years. Relicensure of the limited license is considered the same as renewal" (R 338.1777(3)). LARA's guide states the same ceiling as no more than 10 times.

The Hardship Extension Request

An LLPC who has not finished at the 10-year mark can ask for more time, within limits. "A maximum of three 1-year extension requests will be considered from an individual," and each request has to reach the board "not less than 30 days before the last regularly scheduled board meeting before the expiration date" (R 338.1777(4)). It goes by email to BPLHelp@michigan.gov, and it has to include the ten items listed in R 338.1777(4)(a) to (j):

1. A description of the hardship
2. The cause of the hardship
3. The remedies already attempted
4. Whether the hardship still exists
5. Hours completed toward the requirement
6. Hours remaining
7. Every supervisor, with the periods supervised
8. Every employer, with the periods worked and the nature of the work
9. Exam attempts and their dates
10. Any prior extension request

A complete request is not the same as an approved one. The board's own extension guidelines say it plainly: "The board does not automatically grant the request," and it "may deny the request" (Extension Request Guidelines, rev. 12/12/23).

The Verification Request for Counselors Form

A different LARA form covers a different situation: someone who needs a certified verification of their license that also has to show earned supervision hours. That is the Verification Request for Counselors (LARA/BPL-Counseling-Verif-Health, Rev. 4/24), used only when the certified verification must include those hours. It costs $15.00 per verification and is mailed in with a check, separate from the Counseling Work Experience form that travels with the LPC application itself.

The Professional Disclosure Statement

The other document an LLPC has to keep current is the professional disclosure statement, one per practice location, with changes filed within 30 days (MCL 333.18113(3)). It runs on its own clock, separate from the Counseling Work Experience form and from the hours it records.

Common Mistakes With the Counseling Work Experience Form

Common errors with this form, and what the rules and the form actually say.

Related Michigan Counseling Guides

FAQ: Michigan Counseling Work Experience Form