North Carolina LCMHCA Supervision Reports: Contract, Quarterly and Final

The Supervision Contract Comes First

Before an LCMHCA logs a single supervised hour, the Supervision Contract (Revised 12/18/2025) has to be on file. The form states plainly, "This supervision contract must be received and approved by the NCBLCMHC prior to initiation of supervision," and warns that "hours accrued without a Board-approved contract on file will not be accepted" (Supervision Contract, Revised 12/18/2025). It is sent, per the form's own instructions, "FORMS ACCEPTED VIA EMAIL ONLY TO supervision@ncblcmhc.org."

The contract records the supervisor's name, license type and number, and issuance date; whether the setting is exempt (school, university, or government agency); the physical location where supervision will take place; the modality to be used, checked from Live Observation/Supervision, Co-therapy, Audio Recording, or Video Recording; and the frequency of supervision, a minimum number of hours of individual or group clinical supervision marked weekly, biweekly, or monthly, set against the rule's "minimum one hour of individual or two hours of group supervision per 40 hours of counseling practice" with "at least three-quarters of the hours of clinical supervision" individual (Supervision Contract, Revised 12/18/2025; 21 NCAC 53 .0208). A supervisor who is not already an LCMHCS attests, "I agree to assume responsibility for the clinical work and preparation of this supervisee," and both supervisor and supervisee sign.

One contract does not cover everything. "A separate supervision contract form shall be filed for each separate work setting," and "if receiving supervision from more than one supervisor, a separate supervision contract form shall be filed for each individual qualified clinical supervisor" (21 NCAC 53 .0702(1), (2)). Two jobs or two supervisors means two contracts on file before either one's hours count.

The Quarterly Supervision Report Carries No Hours

The Quarterly Supervision Report (Revised 8/06/2025) is filed by the supervisor, described on its own header as "To be filed for LCMHCAs with approved supervision contracts." The Board sets the due dates on its LCMHCA page: Quarter 1 by April 30, Quarter 2 by July 31, Quarter 3 by October 31, and Quarter 4 by January 31 (Board LCMHCA page).

The form asks the supervisor to attest yes or no to a short list: that the supervisee received "a minimum of 1 hour of individual or 2 hours of group clinical supervision per 40 hours of supervised professional counseling practice"; that the session's focus was on raw data from clinical work; that any individual supervision was face-to-face with one or two supervisees for no less than one hour per session, or a box checked if none was received; that any group supervision was face-to-face, no more than 12 supervisees, no less than two hours per session, or a box checked if none was received; that a clinical supervision log is being maintained; and whether there are ethical or legal concerns to report (Quarterly Supervision Report, Revised 8/06/2025).

No hour totals appear anywhere on it. The Board's LCMHCA page is explicit: "The Board does not require the submission of hours on Quarterly Supervision Reports. All hours are to be reported to the Board on Final Supervision reports" (Board LCMHCA page).

The Supervision Log Stays With the Supervisor

The Supervision Log (Revised 01-7-20) is a sample the Board provides, not a mandatory template: "Supervisors may develop their own form as long as the required elements as defined in Rule .0208 are documented on the log" (Supervision Log, Revised 01-7-20). Under 21 NCAC 53 .0801(e), the supervisor, "in collaboration with the supervisee, shall maintain a log of clinical supervision hours" recording the date, start and stop times, the modality of supervision, and notes on recommendations or interventions used. The sample form's own entry fields match: dates (start and stop), modality (Live, Co-Therapy, Audio, Video), Individual or Group, Direct or Indirect hours, and supervision hours, with a notes line for "recommendation, interviews, etc."

It is not routinely sent to the Board. The form states, "This form is not required to be provided to the NCBLCMHC Board unless formally requested." The retention duty runs longer than the associate's license: the log must be kept "for a minimum of seven years beyond termination or completion of supervision" (21 NCAC 53 .0801(e)).

The Final Supervision Report Is the Only Hours Report

The Final Supervision Report (Revised 8/06/2025) is filed by the supervisor only. Both this form and the Quarterly Supervision Report state, "Self-reporting of hours from the LCMHCA will not be accepted," and it must come by email "directly from the supervisor" with an address matching the one the Board has on file, or through the Counselor Gateway (Final Supervision Report, Revised 8/06/2025).

Section II is headed "To be completed by the supervisor; dates must align with supervision contract approval dates and must be entered to be considered complete." Under it, the form prints four hour fields by name: "Total # Hours Indirect Counseling" and "Total # Hours Direct Counseling" under Supervised Professional Practice, noted "no more than 40 per week"; "Total # Hours" for Individual Clinical Supervision, noted "no less than 1hr per 40 hrs worked"; and "Total # Hours" for Group Clinical Supervision, noted "no less than 2hrs per 40 hrs worked" (Final Supervision Report, Revised 8/06/2025; 21 NCAC 53 .0205(a), .0208, .0210, .0211).

Section IV rates the applicant against 17 characteristics, from individual counseling skills to the ability to keep material confidential, on a scale of "1 = Outstanding" through "6 = Cannot Evaluate." Section V asks the supervisor to recommend or not recommend the applicant for unrestricted licensure, with a printed instruction that the recommendation "should be based solely on the supervisee's clinical performance and demonstrated competencies, rather than on the amount of time or hours remaining to fulfill the 3,000-hour requirement for full licensure or any unrelated factors" (Final Supervision Report, Revised 8/06/2025).

Verification of Supervised Professional Practice

The Verification of Supervised Professional Practice (Revised 6/2/2026) is filed with the LCMHC application. Its instructions state the person completing it "must be a qualified clinical supervisor as defined in Rule .0213 and may not be completed by a relative," and that "Paper submissions are not accepted. This form cannot be submitted by the applicant" (Verification of Supervised Professional Practice, Revised 6/2/2026; 21 NCAC 53 .0213). It goes through the Counselor Gateway or by email to lcmhcinfo@ncblcmhc.org.

Its content mirrors the Final Supervision Report: the same "Total # Hours Indirect Counseling" and "Total # Hours Direct Counseling" fields, the same Individual and Group Clinical Supervision hour totals, the same 17-item professional assessment, and the same recommend or not-recommend reference section. The two forms serve different moments: the Final Supervision Report closes out one supervisor relationship, while the Verification of Supervised Professional Practice supports the application for the LCMHC credential itself.

Every LCMHCA Supervision Form

The Board Sees Hours Only at the End

Look at the order again: the Supervision Contract carries no hours, the Quarterly Supervision Report carries no hours, and the sample Supervision Log is not sent to the Board unless requested. The only two forms with a hour total are the Final Supervision Report and the Verification of Supervised Professional Practice, both filed by the supervisor, both arriving at the end of a supervision relationship or at the LCMHC application itself.

That means an LCMHCA who waits until a supervisor asks for the Final Supervision Report to add up direct, indirect, individual, and group hours is reconstructing months or years of work from memory. Every form above draws from the same four categories, sorted by supervisor and by work setting, since a new setting or a new supervisor means a new contract and a new report. Keeping a running count of those four categories, by supervisor, from the first week of supervision is what makes each of these forms fast to complete when a supervisor sits down to sign one, not a claim about any particular tool.

Common Mistakes on LCMHCA Supervision Forms

Related North Carolina Counselor Guides

FAQ: North Carolina LCMHCA Supervision Reports