Resident in Counseling: Quarterly Evaluation, Verification, and Summary
A Resident in Counseling's supervisor files a Quarterly Evaluation Form "at the end of each three-month period during the residency," and gives the resident a copy; a separate form comes from each supervisor (18VAC115-20-52; Quarterly Evaluation Form - LPC, Rev. 12/2025). It asks only about that quarter: face-to-face client contact hours, total hours of work experience (defined on the form as "time spent delivering clinical counseling services, both directly and through related indirect activities"), whether the resident received "a minimum of one (1) hour and a maximum of four (4) hours of in-person supervision for every 40 hours of supervised work experience this quarter," individual and group supervision hours, and whether another supervisor is also involved. It closes with the supervisor's written feedback, areas of concern, and goals for the next quarter.
The Verification of Supervision Form is different: one form per supervisor, completed once, at the end of that relationship, and notarized. "The applicant must complete only the top portion of this form before providing it to the supervisor," and "if the applicant was supervised by more than one Board-approved supervisor, a separate form must be completed by each supervisor" (Verification of Supervision Form - LPC, Rev. 12/2025). Part IV covers the same 1-to-4-per-40 rate, whether a signed contract was in effect before hours counted, total face-to-face and work-experience hours, individual and group supervision hours, and competency, then closes with a notarized affidavit.
The Supervision Summary Form is filed once, with the LPC application, not per supervisor: "Submit this form with your application for licensure. The total hours from your Verification of Supervision form(s) and Quarterly Evaluation forms should match the total hours on this form" (Supervision Summary Form - LPC, Rev. 12/2025). It holds up to four supervisors, each with a row for face-to-face, work-experience, and individual and group supervision hours, plus a "Hours Duplicated Under Another Supervisor?" column for hours counted twice.
When a supervision relationship ends, either the resident or the supervisor emails the Board a Request for Termination of Supervision Form, and the supervisor signs it (Request for Termination of Supervision Form, Resident in Counseling, Rev. 10/2024). The form repeats the underlying rule: "While providing clinical counseling services, a resident must remain under Board approved supervision until licensed in Virginia as a licensed professional counselor (LPC)" (Request for Termination of Supervision Form, Rev. 10/2024; see 18VAC115-20-70 D). A signed supervisory contract has to be in place first for each supervisor and worksite; the Board's sample contract is a template the resident and supervisor keep on file, not something submitted.
How the LMFT Forms Differ
A Resident in Marriage and Family Therapy uses the same three-form set as a counseling resident, filed the same way (18VAC115-50-60; Quarterly Evaluation Form - LMFT, Rev 12/2025). Every one of them carries a line the counseling forms do not: the Quarterly Evaluation asks "How many of the face-to-face client contact hours were specifically with couples, families, or both?", and the Verification of Supervision Form asks the same question as item d in Part IV (Verification of Supervision Form - LMFT, Rev. 12/2025). Outside that added line, the fields, the notarization, and the one-form-per-supervisor rule match the counseling forms above.
Supervisee in Social Work: Verification, Log, and Extension
The Board of Social Work runs one notarized form in place of the counseling track's three. The Verification of Clinical Supervision form is completed once per supervisor, "the supervisor who supervised the applicant's post-master's degree experience," and "a separate form is required for each supervisor" (Verification of Clinical Supervision, Rev. 09/2024). Notarization has been required as of October 1, 2024. Part IV asks whether the supervisee met the 1-to-4-per-40 rate, individual and group face-to-face supervision hours, then a three-way split the counseling forms lack: "Face-to-Face Client Contact Hours Completed," "Ancillary Hours Completed," and "Total Hours Completed." It closes with seven yes-or-no competency questions (theory base, differential diagnosis, treatment planning, the professional relationship, risk of imminent danger, reporting law, and a professional and ethical relationship with clients), one overall competency question, then the notarized affidavit.
The LCSW Supervision Log Template is not an ordinary submission. "This document is a template for use during approved supervision. You and your supervisor may alter this document as you deem appropriate," with an entry due "at the end of your weekly supervision session" (LCSW Supervision Log Template). Each entry logs the week number, date, individual or group format, supervised hours, face-to-face client contact hours, the topic discussed, services provided, and both signatures. Its own reminder is direct: "you will not need to submit your logs with your application for licensure; however, you will be required to submit these supervision logs if requested by the Board," and supervisors must separately "maintain documentation for five years post-supervision, of which clients were the subject of supervision" (18VAC140-20-50(C)(7)).
A supervisor ends a supervisee's registered supervision the same way a counseling supervisor does, with a Request for Termination of Supervision emailed to the Board (Request for Termination of Supervision, Social Work, Rev. 09/2024). The form warns that if the supervisor will keep supervising the supervisee until the ASWB Clinical exam is passed, the supervision "should not be terminated," since "a supervisee shall remain under board-approved supervision until licensed in Virginia as a licensed clinical social worker" (18VAC140-20-50(D)(5)).
The Board's approval email for Registration of Supervision carries an expiration date, and a supervisee who will not finish within it can request more time on the Extension Request for Supervised Experience, Rev. 09/2024, by returning the form and a copy of the current supervisory contract (18VAC140-20-50 A 3). It asks for the extenuating circumstances, the supervisor and worksite where the supervisee will continue, total face-to-face supervision hours accumulated across all supervisors (individual and group), and total hours of supervised experience accumulated (face-to-face, ancillary, and total). It also has the supervisee attest that starting over means "a new application, fee, and documentation" if the extension is still not enough.
Every Virginia Supervised-Experience Form
| Form | Track | Who Completes | When | Submitted or Kept |
|---|---|---|---|---|
| Quarterly Evaluation Form | Counseling / MFT | Supervisor, signed by both | End of each three-month period | Kept, then submitted with the LPC or LMFT application |
| Verification of Supervision Form | Counseling / MFT | Supervisor; notarized | End of each supervision relationship, one per supervisor | Submitted with the LPC or LMFT application |
| Supervision Summary Form | Counseling / MFT | Applicant | With the licensure application | Submitted with the LPC or LMFT application |
| Termination of Supervision (Counseling) | Counseling / MFT | Resident or supervisor | When supervision ends | Emailed to the Board of Counseling |
| Sample supervisory contract | Counseling / MFT | Resident and supervisor | Before hours count; one per supervisor and worksite | Kept, not submitted |
| Verification of Clinical Supervision | Social Work | Supervisor; notarized | End of supervision, one per supervisor | Submitted with the LCSW application |
| LCSW Supervision Log Template | Social Work | Supervisee and supervisor | Weekly, at the end of each supervision session | Kept; submitted only if the Board requests it |
| Request for Termination of Supervision (Social Work) | Social Work | Supervisor | When supervision ends | Emailed to the Board of Social Work |
| Extension Request for Supervised Experience | Social Work | Supervisee | Before the registration window runs out | Emailed to the Board with the current supervisory contract |
What to Record Every Week So the Forms Add Up
Every form above draws from the same short list of numbers. A counseling or MFT resident's Quarterly Evaluation, Verification of Supervision, and Supervision Summary all ask for face-to-face client contact hours, total hours of work experience, and individual and group in-person supervision hours, sorted by supervisor and by worksite, since a new supervisor or site means a new Verification of Supervision Form and its own row on the Supervision Summary Form. An MFT resident's forms add one more split inside the face-to-face figure: how many hours were with couples, families, or both.
A social work supervisee's Verification of Clinical Supervision form asks for the same face-to-face and supervision breakdown, plus ancillary hours, the case management, recordkeeping, referral, and coordination-of-services time that fills out the total once face-to-face hours are counted. The weekly LCSW Supervision Log Template asks for the same information session by session, recorded "at the end of your weekly supervision session" rather than reconstructed later. None of this is a claim about any particular tool; it is what the forms themselves ask a resident or supervisee to already have on hand before a supervisor signs one.
The Regulation's Own Form List Is Out of Date
The Virginia Administrative Code prints its own appendix of form names at the end of 18VAC115-20, and that appendix still carries titles from 2011. Those names are stale. The Board of Counseling's Applications and Forms page carries the current set, revised 12/2025 for counseling and MFT, and the Board of Social Work's forms page carries its current set, revised 09/2024 for the LCSW forms covered above.
Each form prints its revision date at the bottom. The resident supervision forms covered here read Rev. 12/2025, the counseling termination form Rev. 10/2024, and the social work forms Rev. 09/2024; compare a downloaded copy against the Board's forms page before using it.
Common Mistakes on Virginia's Supervised-Experience Forms
Confusing the Quarterly Evaluation with the Verification of Supervision
The Quarterly Evaluation Form is filed every three months and does not require a notary. The Verification of Supervision Form is filed once per supervisor, at the end of the relationship, and does require a notarized affidavit (18VAC115-20-52 D 3; Verification of Supervision Form - LPC, Rev. 12/2025).
Filing one Verification of Supervision Form for two supervisors
Both verification forms say a separate form is required for each supervisor. Two supervisors means two signed, notarized forms, not one form with two signatures (Verification of Supervision Form - LPC, Rev. 12/2025; Verification of Clinical Supervision, Rev. 09/2024).
Treating the LCSW Supervision Log Template as optional
It is not submitted with the application, but the Board can request it, and its own instructions call for an entry at the end of each weekly session, not a log rebuilt from memory before licensure.
Citing the Virginia Administrative Code's 2011 form appendix
The appendix at the end of 18VAC115-20 still names 2011 forms. The Board's current forms page, not the code's appendix, carries the set in use today.
Skipping the Supervision Summary Form's duplicated-hours column
A resident supervised by more than one Board-approved supervisor at once has to mark whether hours on the Supervision Summary Form were also counted under another supervisor, and record the number of duplicate hours if so.
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Related Virginia Guides
Virginia LPC Requirements
The Resident in Counseling to LPC path these forms document: hours, duration, and supervision.
Virginia LCSW Requirements
The Registration of Supervision to LCSW path this page's social work forms document.
Virginia LMFT Requirements
The Resident in Marriage and Family Therapy path behind the LMFT versions of these forms.
Resident in Counseling in Virginia
What the Resident in Counseling credential is before any of these forms come into play.
Registration of Supervision in Virginia
The Registration of Supervision that starts the social work supervision these forms verify.
How to Become a Therapist in Virginia
The full path across Virginia's counseling, social work, and marriage and family therapy tracks.
FAQ: Virginia Supervised Experience Forms
What does the Virginia Board of Counseling's Quarterly Evaluation Form ask for?▾
The Quarterly Evaluation Form asks for that quarter only: face-to-face client contact hours, total hours of work experience, whether the resident received one to four hours of in-person supervision per 40 hours of work experience, and individual and group supervision hours. Supervisors are required by 18VAC115-20-52 to complete it at the end of each three-month period during the residency and give a copy to the resident (Quarterly Evaluation Form - LPC, Rev. 12/2025). The Marriage and Family Therapy version asks the same set, plus how many hours were with couples or families (18VAC115-50-60).
What is the Verification of Supervision Form for a Virginia LPC?▾
It is the form a resident's supervisor completes once, at the end of the supervision relationship, to verify the resident's total hours under that supervisor. The applicant fills in only the top section before handing it to the supervisor, who completes Part IV: the supervision rate, whether a signed contract was in effect before hours counted, total face-to-face and work experience hours, individual and group supervision hours, and competency. It requires a notarized affidavit, and a separate form is required for each supervisor (Verification of Supervision Form - LPC, Rev. 12/2025).
What does the Virginia LCSW Verification of Clinical Supervision form require?▾
The supervisor completes Part IV: whether the supervisee received one to four hours of face-to-face supervision per 40 hours of work experience, individual and group supervision hours, face-to-face client contact hours, ancillary hours, total hours, and seven yes-or-no competency questions covering theory base, differential diagnosis, treatment planning, the professional relationship, risk assessment, a professional and ethical relationship with clients, and reporting law. The form requires a notarized affidavit, notarization required as of October 1, 2024, and a separate form for each supervisor (Verification of Clinical Supervision, Rev. 09/2024).
Is a Virginia LCSW supervision log submitted to the Board?▾
No, not with the application. The LCSW Supervision Log Template tells the supervisee and supervisor to record an entry at the end of every weekly supervision session, but the applicant is told, "you will not need to submit your logs with your application for licensure," only if the Board requests them for verification (LCSW Supervision Log Template). Supervisors are separately required to keep documentation for five years post-supervision of which clients were discussed (18VAC140-20-50(C)(7)).
Where do I find the Virginia Board of Counseling's current forms?▾
On the Board's Applications and Forms page. The Virginia Administrative Code's own appendix at the end of 18VAC115-20 still lists 2011 form titles, which are stale; the Board's forms page carries the current Rev. 12/2025 set for counseling and Rev. 09/2024 set for social work. Always confirm the revision date printed at the bottom of a downloaded form before using it.
Does the Virginia LMFT Quarterly Evaluation Form differ from the LPC version?▾
Only by one line. The LMFT Quarterly Evaluation Form (18VAC115-50-60) asks every question the LPC version asks, plus a separate line asking how many of that quarter's face-to-face client contact hours were specifically with couples, families, or both. The Verification of Supervision Form for LMFT carries the same addition, as item d in Part IV (Verification of Supervision Form - LMFT, Rev. 12/2025).
Requirements verified against 18VAC115-20, 18VAC115-50, and 18VAC140-20 of the Virginia Administrative Code, and the Virginia Board of Counseling and Virginia Board of Social Work forms and handbooks, current as of September 2026. Forms, revisions, and regulations can change. Confirm the current version at the Virginia Board of Counseling or Virginia Board of Social Work before submitting any form. This guide is for informational purposes only and does not constitute legal or professional advice.