Two Forms, Two Different Moments
An LMSW working toward LCSW under the Texas Behavioral Health Executive Council (BHEC) touches two forms with similar names and opposite jobs. The Clinical Supervision Plan comes first. It is signed by the LMSW and the LCSW-S before any hours accrue, and it gates whether the hours that follow count toward licensure at all. The Clinical Supervision Verification Form comes at the end of a supervisory relationship. It reports what actually happened: months, supervision hours, and clinical experience hours.
Mixing the two up, or starting hours before the Plan is signed, is a paperwork mistake to avoid on this track. The rest of this page walks through both, field by field, plus what the other social work paperwork asks for along the way.
One structural point makes the Texas social work track different from the LPC and LMFT tracks it sits alongside. The Texas LMSW license is a renewable Council license, not a time-limited associate registration. The pre-LCSW status is not a license type of its own; it is an LMSW who has signed a Clinical Supervision Plan with an LCSW-S. There is no separate associate number beyond the Texas LMSW license itself, which is exactly why the Plan carries so much weight: it is the document that turns an ordinary LMSW license into a license on the LCSW path.
The Clinical Supervision Plan
The current Clinical Supervision Plan is Clinical-Supervision-Plan_SafeHarbor-form-2021July.docx, a Word document whose file name carries 2021July, available on the SW Forms and Publications page. It is signed by both the LMSW and the LCSW-S before hours begin accruing (22 TAC 781.405(a)). The Plan form says one completed form per supervisor must be submitted at the time of the LCSW application.
Here is what the Plan form contains, in the order it appears.
| Section | What it asks |
|---|---|
| Opening statement | Each practice location must encompass the role of social work, and at least one practice location must provide the supervisee a minimum of four hours per week of direct clinical practice |
| Supervisee (LMSW) | Name, license number, email address and phone |
| Supervisor (LCSW-S) | Name, license number, email address and phone |
| Records the supervisor and supervisee must maintain | Written approval from the employing agency when the LCSW-S is not employed by the LMSW's agency (on agency letterhead, dated and signed by an agency representative, with a confidentiality agreement and authorization to discuss cases); a list of practice locations with start and end dates; the LMSW's job description and responsibilities for each location; an ongoing log of clinical experience and supervision hours; signed supervision notes with the content, duration and date of each session; and an individualized written remediation plan if the LCSW-S determines the LMSW lacks professional skills or competence |
| Acknowledgment of understanding | Seven statements the LMSW and LCSW-S attest to, including that the information is true (Penal Code 37.10; 22 TAC 882.34), that they will follow the laws and rules governing social work and supervised experience, that the supervisor and supervisee bear responsibility for the supervisee's professional activities, that the supervisor knows the conditions of exchange used with clients (22 TAC 781.102(11)), that neither will exceed their competence or scope, that neither will have a relationship that impairs objective judgment, and that both are jointly responsible for updating the agreed goals whenever there is a change in agency of employment, job function, or method by which supervision is provided |
| Signatures | Supervisee (LMSW) signature and date; supervisor (LCSW-S) signature and date |
| Submission | One completed form per supervisor must be submitted at the time of LCSW application |
Rule 781.405(a) allows "a form prescribed by the Council or a form with substantially equivalent information." The supervisor is responsible for updating the plan whenever there is a change in agency of employment, job function, goals for supervision, or method by which supervision is provided (22 TAC 781.403(b)(2)).
If you searched for a clinical supervision plan example because your agency wants to use its own paperwork, the question that matters is whether that internal document carries the same information as the Council's form, since 781.405(a) is worded around substance, not a specific template. An LMSW and LCSW-S weighing an agency version against the Council's own Plan should compare it field by field against the description above before assuming it qualifies.
When Your Supervisor Is Not Your Employer
For an LCSW-S who is not employed by your agency, the rule allows a social worker to supervise someone employed in another setting only with the employer's written approval (22 TAC 781.403(a)(2)), and the Plan form calls for it on agency letterhead, dated and signed by an agency representative. That approval is part of the supervisor's file alongside the Plan, job description, practice locations, and the log of your sessions (781.403(b)(1)).
The Clinical Supervision Verification Form, Field by Field
The current Verification form is SW-Clinical-Superision-Verification-form-9.25.25.docx, also a Word document. Yes, the misspelling of "Superision" is in BHEC's own filename. If your search results turn up that spelling, you have found the right file.
Each LCSW-S completes a Verification form covering the period they supervised you, and you initial and sign Section V with them. Here is what it asks for.
| Field | What It Captures |
|---|---|
| Section I, supervisee | Supervisee name, license number and email address |
| Section II, supervisor | Supervisor name, license number and email address (completed by the supervisor) |
| Section III, dates | From and to dates of the supervision, in MM/DD/YYYY |
| Total months | Total months of supervision; the form says supervision hours and months must be in whole numbers |
| Total supervision hours | Hours for the period, to be applied to the 100-hour requirement (22 TAC 781.401(a)(1)(D)) |
| Total clinical experience hours | Hours of supervised professional clinical experience worked during the period, to be applied to the 3,000-hour requirement (22 TAC 781.401(a)(1)(C)) |
| Section IV, recommendation | Whether the supervisor has any reservations about the applicant being granted an LCSW license, Yes or No; a Yes needs a letter outlining the concerns |
| Section V, affidavit and signatures | Two statements initialed by both the supervisor and the supervisee (one certifying review of the supervision regulations, one an affirmation under penalties of perjury), then signature, date and printed name for each |
| Mail To | The form prints TBHEC, Ste. 7.300, 1801 Congress, Austin, TX 78701 |
The form prints a mailing address, and BHEC's Supervision FAQs page has also told LCSW supervisors to email it (see the timing section below). Keeping the two numbers straight before that point is easier with hours tracking for Texas associates built around the same per-supervisor totals the form asks for.
HourJourney fills in your verification form
One Clinical Supervision Verification form per supervisor, with the dates, months, supervision hours and clinical hours from your log, ready for signature.
The Two Numbers on the Verification Form, and Why They Are Separate
Total supervision hours and total clinical experience hours are not the same number, and the Verification form keeps them apart on purpose. Supervision hours count toward the 100-hour minimum (22 TAC 781.401(a)(1)(D)) and are capped at 10 counted in any one month or 30-day period (781.403(b)(8)). Clinical experience hours count toward the 3,000-hour total (781.401(a)(1)(C)) and are not split into direct and indirect the way some other Texas tracks are; see what counts as clinical hours for LCSW in Texas for how that single figure is defined. Whole months matter on top of both numbers, because supervision must extend to at least 24 full months even if the hours finish earlier (781.403(b)(7)).
Here is a clean version of the arithmetic across two supervisors, the kind Texas LCSW supervision requirements lays out in full.
| Supervisor | Months | Supervision Hrs | Clinical Experience Hrs |
|---|---|---|---|
| First supervisor | 12 | 50 | 1,500 |
| Second supervisor | 12 | 50 | 1,500 |
| Combined | 24 | 100 | 3,000 |
Twenty-four months meets the minimum duration exactly (781.401(a)(1)(C); 781.403(b)(7)). Fifty supervision hours a year averages a little over 4 hours a month, well under the 10-hour monthly cap, and the two totals reach 100 hours combined. 1,500 plus 1,500 reaches the full 3,000-hour requirement. None of that works if an LMSW keeps one combined running number instead of two totals split by supervisor, since each Verification form only certifies what one LCSW-S personally supervised.
HourJourney keeps a separate form for each supervisor
Your export lists one form per supervisor, each with its own dates and hours.
Who Files, and How Long a Supervisor Has
On the LMSW's request, the LCSW-S must submit a completed and signed Verification form within 30 days (22 TAC 781.405(c)), and the applicant's file must contain it (781.405(b)(1)). That clock starts when you ask for the form, so asking early, rather than waiting until the LCSW application is otherwise complete, keeps a slow-moving supervisor from becoming a bottleneck.
As of September 2026, BHEC's Supervision FAQs page said the online supervision module for social work was unavailable and told LCSW supervisors to email Clinical Supervision Plans and Verification forms to socialwork@bhec.texas.gov. Check that page for the current instruction.
One more timing note worth keeping in mind: 22 TAC 781.402, 781.403, 781.405, 781.406, and 781.407 are all new rules, effective March 18, 2026. The Verification form's file name carries 9.25.25, which is earlier than those rules. Pull the current file from the SW Forms and Publications page each time you need one rather than reusing a saved copy, in case BHEC issues a new version to match the updated chapter.
The 30-day clock also has a practical wrinkle worth planning around: it applies to the Verification form, not the Plan. There is no comparable deadline forcing an LCSW-S to sign the Plan quickly at the start of supervision, which is exactly why the burden falls on the LMSW to get that first signature before any hours are logged, rather than waiting for a form the rule does not put on a clock.
Send it for signature from the HourJourney app
With Plus, email the form to your supervisor from the app, with you on reply-to.
The Rest of the Social Work Paperwork
The Plan and the Verification form are not the only documentation in an LMSW's file. Here is the rest of it.
| Item | Detail |
|---|---|
| Social Work Checklist and Licensure Process | SW-Application-Checklist-20260720sf.pdf, July 20, 2026 |
| Supervisor contacts | Names and contact information for every supervisor |
| Dates | Beginning and ending dates with each supervisor |
| Job description | A written description of the position |
| Weekly average | Average hours of social work activity per week |
| Evaluations | The experience must be under a qualified supervisor with written evaluations to demonstrate satisfactory performance (781.405(b)(2)) |
| On request | Employment status, pay vouchers, or supervisory evaluations, provided on request (781.405(b)(3)) |
The application-stage documentation rows above come from 22 TAC 781.405(b)(1) through (3). None of it replaces the Plan or the Verification form; it sits alongside them in the file the Council reviews at your LCSW application.
What People Mean by "Supervision Contract" and "Supervision Log"
Two terms come up in searches about this track. Chapter 781 names a supervision plan; it does not define a separate supervision contract document. The Clinical Supervision Plan is the signed form that establishes the relationship before hours begin.
The running log people ask about is not a form you submit. Rule 781.403(b)(1) has the supervisor's file hold a log of experience and supervision hours, including the date and duration of each meeting and accumulated clinical hours, and the Plan form has the supervisor and supervisee both maintain an ongoing log. That log helps your LCSW-S arrive at accurate totals when it is time to complete the Verification form. The rule requires the supervision plans and verification forms (781.405(b)(1)); a personal log or spreadsheet is not a substitute.
Common Mistakes With These Forms
These are errors to avoid in the LCSW paperwork.
Starting hours before the Plan is signed
The rule has the LMSW and the LCSW-S complete a supervision plan to accrue supervised clinical experience (22 TAC 781.405(a)).
Treating the Plan as a one-time filing
The supervisor is responsible for updating the Plan on a change in agency of employment, job function, goals, or method (22 TAC 781.403(b)(2)), and the Plan form makes both parties jointly responsible.
Using an outside supervisor without employer approval
The rule allows supervising someone employed elsewhere only with the employer's written approval (22 TAC 781.403(a)(2)); the Plan form calls for it on agency letterhead.
Mixing up the two numbers on the Verification form
Total supervision hours count toward the 100-hour minimum; total clinical experience hours count toward the 3,000-hour total. They are not the same figure.
Waiting on an online portal that was not working
As of September 2026, the online supervision module for social work was unavailable. Confirm with your supervisor that both forms go to socialwork@bhec.texas.gov by email.
Downloading an old copy of the Verification form
The current file's name carries 9.25.25, which is earlier than the rules effective March 18, 2026. Pull the current version from the SW Forms and Publications page rather than a saved copy.
How HourJourney Tracks This for the LMSW to LCSW Path
HourJourney keeps the two Verification-form numbers separate by supervisor from the day you log your first week:
- ✓Total clinical experience hours and total supervision hours tracked separately per supervisor, not as one combined figure
- ✓A checklist item for the 24-full-month minimum alongside your hours
- ✓A running check against the 10-hour monthly supervision cap
- ✓A generated Clinical Supervision Verification Form as a PDF replica carrying the same information, one per supervisor, with initials and signatures left blank
- ✓A record that survives a change of supervisor without reconstruction
Built for Texas pre-licensed clinicians.
Related Guides
Texas LCSW Hours Requirements
The full 3,000-hour and 100 supervision-hour breakdown behind these forms.
Texas LCSW Supervision Requirements
The 100-hour minimum, the monthly cap, and who can supervise you.
LMSW to LCSW in Texas
The full path from the LMSW license to LCSW.
The Texas LMSW License
What the LMSW license is and how it differs from an associate registration.
What Counts as Clinical Hours for LCSW in Texas
How the 3,000 clinical experience hours are defined.
Texas LCSW Hours Calculator
Estimate your finish date against the 3,000 hours, 100 supervision hours and 24-month minimum.
Hours Tracking for Texas Associates
How HourJourney logs and totals your Texas supervision hours.
Texas Supervisor Change Form
How LPC and LMFT handle a supervisor change, and what the LCSW rule leaves out.
FAQ: The Texas LCSW Clinical Supervision Plan and Verification Form
What is a Clinical Supervision Plan in Texas?▾
The Clinical Supervision Plan is the form an LMSW and an LCSW-S sign together to start the LCSW supervision process. It records the LMSW's and LCSW-S's information, lists the records the supervisor and supervisee must maintain, and states the condition that at least one practice location provide the supervisee a minimum of four hours per week of direct clinical practice. The current version is Clinical-Supervision-Plan_SafeHarbor-form-2021July.docx, from July 2021 (22 TAC 781.405(a)).
When do you have to file the Clinical Supervision Plan?▾
It is signed before hours accrue. The rule has the LMSW and the LCSW-S complete a supervision plan to accrue supervised clinical experience (22 TAC 781.405(a)). The Plan form says one completed form per supervisor must be submitted at the time of the LCSW application.
Can you use your own supervision plan form instead of the Council's?▾
Yes, within limits. Rule 781.405(a) allows a form prescribed by the Council or a form with substantially equivalent information, signed by both the LMSW and the LCSW supervisor (22 TAC 781.405(a)). The Council's own form is the sure way to capture everything it asks for.
Who fills out the LCSW Verification form?▾
The LCSW-S completes Sections II to IV of the Clinical Supervision Verification Form, and both the LMSW and the LCSW-S initial and sign Section V. The LMSW's role is to keep accurate running totals of clinical experience hours and supervision hours so the supervisor has correct numbers to enter for the period they supervised.
How long does a supervisor have to submit the Verification form?▾
A supervisor must submit the signed Verification form within 30 days of the LMSW's request (22 TAC 781.405(c)). The clock starts when the LMSW asks, not automatically at the end of supervision, so ask for the form as soon as you need it rather than assuming your supervisor will file it unprompted.
Where do you send the Texas LCSW supervision forms?▾
The Verification form prints a mailing address only: TBHEC, Ste. 7.300, 1801 Congress, Austin, TX 78701. As of September 2026, BHEC's Supervision FAQs page said the online supervision module for social work was unavailable and told LCSW supervisors to email Clinical Supervision Plans and Verification forms to socialwork@bhec.texas.gov. Check that page for the current instruction.
Do you need one set of forms per supervisor?▾
Yes. The Plan form says one completed form per supervisor must be submitted with the LCSW application, and the Verification form is completed by one supervisor (22 TAC 781.405(b)(1), (c)). An LMSW supervised by two LCSW-S supervisors over their 3,000 hours needs a signed Plan and a signed Verification form from each one, not a single combined set.
Does BHEC accept a supervision log instead of these forms?▾
The rule requires the supervision plans and verification forms (22 TAC 781.405(b)(1)); no BHEC social work instrument names a log as a substitute. A running log is something the supervisor keeps in the supervisor's file (781.403(b)(1)), and the Plan form has the supervisor and supervisee both maintain an ongoing log. It helps produce accurate numbers for the Verification form.
On another Texas track? See Supervised Experience Verification form.
Requirements verified against the consolidated Social Work Rulebook (March 2026) and the BHEC SW Forms and Publications page, current as of September 2026. Rules and forms can change. Always confirm current requirements at bhec.texas.gov before making decisions about your licensure path. This guide is for informational purposes only and does not constitute legal or professional advice.