Oklahoma Administrative Code
Title 86 - State Board of Behavioral Health Licensure
Chapter 15 - Licensed Marital and Family Therapists
Subchapter 5 - Application for Licensure
Section 86:15-5-4 - Additional forms

Universal Citation: OK Admin Code 86:15-5-4

Current through Vol. 42, No. 1, September 16, 2024

(a) Out-of-State License Verification Form - identifying information; type of credential held in other state; license number; issue and expiration date of license; current standing of license; past complaints or sanctions; exam information; supervision information; graduate education; internship documentation; signature and identifying information of person verifying from out-of-state.

(b) The Termination of Supervision Agreement requires the following information:

(1) name of candidate;

(2) current place of employment of candidate;

(3) address of current place of employment of candidate;

(4) phone number of candidate;

(5) email address of candidate;

(6) signature and signature date of candidate, (if available);

(7) name of supervisor;

(8) license number of supervisor;

(9) current place of employment of supervisor;

(10) phone number of supervisor;

(11) email address of supervisor;

(12) signature and signature date of supervisor, (if available); and

(13) effective date of termination of supervision agreement.

Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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