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Board Of Behavioral Sciences - Marriage And Family Therapist Trainee / Intern Weekly Summary Of Hours Of Experience

STATE OF CALIFORNIA – BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY

Governor Edmund G. Brown Jr.

Board of Behavioral Sciences

1625 North Market Blvd., Suite S200, Sacramento, CA 95834

Telephone: (916) 574-7830

TTY: (800) 326-2297

MARRIAGE AND FAMILY THERAPIST TRAINEE / INTERN

WEEKLY SUMMARY OF HOURS OF EXPERIENCE

OPTION 1 – NEW STREAMLINED METHOD

Name of Trainee/Intern:

Last

First

Middle

Supervisor Name

Date enrolled in graduate degree program

Name of Work Setting

Address of Work Setting

(use a separate log for each)

Indicate your status when the hours below are logged:

Trainee

Post-Degree / Intern Application Pending - BBS File No (if known): ________________

Registered Intern - MFT Intern Number: _______________

Total

YEAR __________

WEEK OF:

Hours

A. Direct Counseling with Individuals,

Groups, Couples or Families

A1. Diagnosis and Treatment of Couples,

Families, Children*

B. Non-Clinical Experience**

B1. Supervision, Individual*

B2. Supervision, Group*

C. Total Hours Per Week

(A + B = C) (Maximum 40 hours / week)

* Line A1 is a sub-category of “A” and Lines B1 and B2 are subcategories of “B.” When totaling weekly

hours do NOT include the subcategories - use the formula found in box “C.”

**Non-Clinical Experience includes: Supervision, psychological testing, writing clinical reports, writing

progress or process notes, client-centered advocacy, and workshops, seminars, training sessions or

conferences.

37A-525 (Revised 05/2016)

Board Of Behavioral Sciences - Marriage And Family Therapist Trainee / Intern Weekly Summary Of Hours Of Experience