---
title: Licensed Professional Counselor Supervision Program Application Form Template | Paperform
description: Professional LPC supervision application form for mental health supervisors. Collect provisional license, theoretical orientation, client experience, and supervision preferences in one organized template.
url: "https://paperform.co/templates/licensed-professional-counselor-supervision-program-application"
type: static
generatedAt: "2026-03-28T00:44:22.906Z"
---

[← Back to free form templates](/templates/)    ![Licensed Professional Counselor Supervision Program Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/licensed-professional-counselor-supervision-program-application.png)
    [Preview](https://_preview.paperform.co/ai-template/licensed-professional-counselor-supervision-program-application) [Use this template for free](/create?ai-template=licensed-professional-counselor-supervision-program-application)    [Application Forms](/templates/category/applications/) [Consulting](/templates/industry/consulting/)[Coaching](/templates/industry/coaching/)[Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/) [Therapist](/templates/role/therapist/)[Counselor](/templates/role/counselor/)[Psychologist](/templates/role/psychologist/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Licensed Professional Counselor Supervision Program Application Template

Finding the right clinical supervision is a critical step in your journey from provisional licensure to full professional counselor certification. Whether you're pursuing your LPC, LMFT, or other mental health credentials, the supervision hours you log will shape your clinical identity and prepare you for independent practice.

This **LPC supervision program application form** helps supervisors and group practice owners efficiently collect everything they need to match provisional license holders with the right supervision experience—all while maintaining professional standards and clear agreements from day one.

#### Designed for mental health professionals and supervision practices

This Paperform template is purpose-built for:

 - **Private practice supervisors** offering individual or group supervision to provisionally licensed clinicians
 - **Community mental health centers** managing clinical supervision programs for associate counselors
 - **Group practices and therapy collectives** providing internal supervision tracks
 - **University counseling centers** coordinating post-graduate supervision for recent graduates
 - **Independent clinicians** managing a small cohort of supervisees

Whether you're a seasoned supervisor building out a formal program or a solo practitioner taking on your first supervisee, this form replaces scattered intake paperwork with a single, organized application that covers licensing details, clinical background, theoretical preferences and supervision logistics.

#### What's included in this supervision application template

This form walks applicants through everything a supervisor needs to know before beginning the relationship:

 - **Personal and contact information** to establish the supervisory relationship
 - **Provisional license upload** so you can verify credentials and track expiration dates
 - **Licensure status and requirements** including hours needed, jurisdiction and timeline
 - **Theoretical orientation assessment** to ensure philosophical alignment between supervisor and supervisee
 - **Client population experience** covering age groups, presenting issues and practice settings
 - **Supervision format preferences** (individual vs. group) with scheduling availability
 - **Hourly rate agreement acknowledgment** to confirm financial terms upfront
 - **Professional goals and learning objectives** so you can tailor supervision to the clinician's development

The form uses conditional logic to adapt based on the applicant's license type and supervision needs, making it relevant whether they're seeking 100 hours or 3,000 hours of post-degree supervision.

#### Streamline onboarding and maintain compliance

Managing supervision relationships comes with real regulatory responsibility. This template helps you:

 - **Verify provisional licenses** before supervision begins, with uploaded documentation stored securely
 - **Document supervision agreements** including rate, frequency and format in writing
 - **Track clinical competencies** by capturing baseline experience with different populations and modalities
 - **Match supervisees thoughtfully** by understanding their theoretical leanings and professional goals
 - **Stay organized** with submissions that feed directly into your CRM, practice management software or spreadsheet

Use Paperform's conditional confirmations to send different next steps based on whether you're accepting individual vs. group supervisees, or to route applications to different supervisors on your team.

#### Integrate with your practice management tools

Paperform connects seamlessly with the tools mental health professionals already use:

 - Send new applications to **Google Sheets** or **Airtable** to track your supervision cohort
 - Push applicant details into **SimplePractice, TherapyNotes** or other EHR systems via Stepper or Zapier
 - Notify your team in **Slack** when a new supervision application comes in
 - Create automatic reminders in **Notion** or project tools to follow up on incomplete applications
 - Use **Papersign** to follow up with a formal supervision contract once the application is approved

With **Stepper**, Paperform's AI-native workflow builder, you can automate your entire supervision onboarding process—verify the license, send the contract, schedule the intake meeting and add the supervisee to your calendar, all triggered by a single form submission.

#### Built with HIPAA-adjacent best practices in mind

While Paperform is not HIPAA compliant and should not be used to collect protected health information, this template is designed to collect only **professional credentials and supervision preferences**—not client data or clinical records. That makes it appropriate for the intake and application phase of the supervision relationship, before any clinical material is discussed.

You can customize the form to include your own confidentiality agreements, informed consent language and supervision policies, ensuring supervisees understand their responsibilities from the start.

#### Flexible design that reflects your supervision philosophy

Paperform's document-style editor lets you shape this template to match your practice:

 - Add your **practice logo, photos and colors** to make the form feel personal and on-brand
 - Include **welcome videos** explaining your supervision style and what supervisees can expect
 - Embed **testimonials from past supervisees** to help applicants understand your approach
 - Customize the **theoretical orientation options** to reflect the modalities you supervise (CBT, psychodynamic, humanistic, integrative, etc.)
 - Adjust **rate and scheduling fields** to match your availability and pricing structure

You can use Paperform's Guided Mode for a conversational, one-question-at-a-time experience that feels less like a bureaucratic application and more like a professional intake conversation.

#### Who benefits from this template

This form is trusted by mental health supervisors, clinical directors and group practice owners across the U.S. and internationally. It's especially valuable for:

 - **LPC, LMFT, LCSW and LMHC supervisors** managing provisional license holders
 - **Training directors** at agencies coordinating supervision for multiple clinicians
 - **Private practitioners** who supervise as a secondary income stream or mentorship contribution
 - **University faculty** offering post-graduate supervision as part of fieldwork or externships
 - **Telehealth practices** providing remote supervision across state lines

If you're managing multiple supervisees, Paperform's Agency+ plan lets you create separate forms for different supervision tracks (e.g., trauma-focused, couples therapy, child/adolescent) under one account.

#### Get started in minutes

This template is ready to use as-is or customize in Paperform's editor. No coding required, no design skills needed. Just type, format and publish. You can embed the form on your practice website, share it via a custom link or even host it on your own domain.

With SOC 2 Type II compliance, data residency controls and role-based permissions, Paperform gives you the security and professionalism your supervision program deserves—without the enterprise complexity.

Start matching with the right supervisees, maintain compliance with licensing boards and spend less time on admin so you can focus on what matters: mentoring the next generation of mental health professionals.

---

**Related templates:** Therapy intake forms, counseling supervision contract templates, clinical training applications, mental health professional registration forms.

**Integrations:** Works seamlessly with SimplePractice, TherapyNotes, Google Workspace, Airtable, Slack, Stepper and 3,000+ other tools via Zapier and Make.

**Industries:** Mental health, healthcare, education, professional services, coaching.

**Roles:** Therapists, counselors, clinical directors, training coordinators, private practice owners, mental health supervisors.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Dialectical Behavior Therapy (DBT) Skills Group Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/dialectical-behavior-therapy-dbt-skills-group-enrollment-form.png)

### Dialectical Behavior Therapy (DBT) Skills Group Enrollment Form

A comprehensive enrollment form for DBT skills groups covering emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness training with homework tracking.](/templates/dialectical-behavior-therapy-dbt-skills-group-enrollment-form/)
[![Existential Therapy Session Booking Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/existential-therapy-session-booking-form.png)

### Existential Therapy Session Booking Form

A thoughtful intake and booking form for existential therapy sessions that explores meaning-making goals, death anxiety, freedom, responsibility, and connection themes.](/templates/existential-therapy-session-booking-form/)
[![Residential Treatment Program Application - Sexual Compulsivity Recovery](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/residential-treatment-program-application-sexual-compulsivity-recovery.png)

### Residential Treatment Program Application - Sexual Compulsivity Recovery

A comprehensive application for residential treatment programs specializing in sexual compulsivity recovery, including behavior pattern assessment, accountability planning, and partner support coordination.](/templates/residential-treatment-program-application-sexual-compulsivity-recovery/)
[![Animal-Assisted Therapy Certification Scholarship Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/animal-assisted-therapy-certification-scholarship-application.png)

### Animal-Assisted Therapy Certification Scholarship Application

A comprehensive scholarship application for aspiring animal-assisted therapy practitioners seeking certification funding, including therapy animal handling experience, special populations interest, and professional recommendations.](/templates/animal-assisted-therapy-certification-scholarship-application/)
[![Brainspotting Therapy Consultation Booking Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/brainspotting-therapy-consultation-booking-form.png)

### Brainspotting Therapy Consultation Booking Form

Book your initial brainspotting therapy consultation to explore trauma processing, dual attunement techniques, and personalized healing approaches.](/templates/brainspotting-therapy-consultation-booking-form/)
[![DBT Skills Group Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/dbt-skills-group-enrollment-form.png)

### DBT Skills Group Enrollment Form

A comprehensive enrollment form for dialectical behavior therapy (DBT) skills groups that assesses participant interests in core modules, establishes goals, and confirms commitment to the therapeutic process.](/templates/dbt-skills-group-enrollment-form/)
[![Emotionally Focused Therapy for Couples - Intake & Booking](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/emotionally-focused-therapy-for-couples-intake-booking.png)

### Emotionally Focused Therapy for Couples - Intake & Booking

A comprehensive couples therapy intake form for Emotionally Focused Therapy (EFT) sessions, including attachment style assessment, cycle mapping introduction, and vulnerability readiness evaluation to prepare couples for their therapeutic journey.](/templates/emotionally-focused-therapy-for-couples-intake-booking/)
[![Equine Therapy Certification Program Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/equine-therapy-certification-program-application.png)

### Equine Therapy Certification Program Application

Apply for professional certification in equine-assisted therapy. Comprehensive application for practitioners seeking to integrate horses into therapeutic practice.](/templates/equine-therapy-certification-program-application/)
[![Infant Mental Health Specialist Program Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/infant-mental-health-specialist-program-application.png)

### Infant Mental Health Specialist Program Application

Comprehensive application for infant mental health specialist training and endorsement, covering early childhood credentials, attachment theory expertise, and reflective practice commitment.](/templates/infant-mental-health-specialist-program-application/)
[![Intensive Outpatient Program (IOP) Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/intensive-outpatient-program-iop-enrollment-form.png)

### Intensive Outpatient Program (IOP) Enrollment Form

Streamline enrollment for intensive outpatient mental health and substance abuse programs with comprehensive intake, scheduling, and insurance verification.](/templates/intensive-outpatient-program-iop-enrollment-form/)
[![Reality Therapy Session Booking Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/reality-therapy-session-booking-form.png)

### Reality Therapy Session Booking Form

A comprehensive intake and booking form for reality therapy sessions that incorporates choice theory principles, the WDEP model, and quality world exploration to help therapists prepare for meaningful client work.](/templates/reality-therapy-session-booking-form/)
[![Residential OCD Treatment Program Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/residential-ocd-treatment-program-application.png)

### Residential OCD Treatment Program Application

A comprehensive application form for residential OCD treatment programs specializing in contamination fears, ERP therapy readiness assessment, and family accommodation evaluation.](/templates/residential-ocd-treatment-program-application/)