How to Complete and Submit the California BBS Experience Verification Form

The California BBS Experience Verification form is the document your supervisor uses to confirm the supervised clinical hours you completed toward licensure as an LMFT, LCSW, or LPCC. You pick the correct version for your license type, provide the supervisor and employer details, log your hours by category, and submit a separate form for every supervisor-and-workplace combination as part of your full application package. Get the categories and totals right the first time and you move on to the clinical exam. Get them wrong and the board mails back a deficiency notice.

Choose the Right Form for Your License

The BBS publishes a different in-state experience verification form for each license category, and each one is tied to the statute governing that profession:

LMFT: Marriage and Family Therapist In-State Experience Verification (Form 37A-301), under Business and Professions Code section 4980.43.¹
LCSW: Clinical Social Worker In-State Experience Verification, under BPC section 4996.23.²
LPCC: Professional Clinical Counselor In-State Experience Verification (Form 37A-675), under BPC section 4999.46.³

All three license types require 3,000 total supervised hours earned over a minimum of 104 weeks.⁴⁵ Download the current version directly from the BBS website. A copy your employer or supervisor keeps on file may be out of date, and using an outdated form or the wrong license type’s form can cause the board to return your entire application.

In-State Versus Out-of-State, and Pre- Versus Post-Degree

The in-state forms only cover California hours. The LMFT in-state form specifically states it is to be completed by your California supervisor.⁶ For hours earned outside California, the BBS publishes separate out-of-state/out-of-country verification forms; for LMFT applicants that is Form 37A-304.⁷ Check the BBS forms page for the equivalent LCSW and LPCC versions.

Pre-degree and post-degree experience also go on separate forms. The LMFT form instructs applicants to use one form for each period.⁶ For LCSW applicants, post-degree hours earned before your associate registration was issued can still count if you applied for registration within 90 days of earning your qualifying degree, your workplace required Live Scan fingerprinting, and the board later granted your registration.²

Gather Your Information Before You Start

Have everything in front of you before you fill anything in. Tracking down a former supervisor’s license number after the fact is where applicants lose weeks.

Supervisor details: full name, email, business phone, license type, license number, and the date they were first licensed.⁶
Employer details: legal business name, phone number, and full street address.⁸
Your hour logs: a breakdown by category (individual supervision, group supervision, direct client contact, and other qualifying activities) with exact start and end dates for each supervisory arrangement.

If your supervisor was licensed in California for less than two years on the first date of experience you are claiming, the LMFT form requires them to attach their out-of-state license information.⁶ Flag this early so your supervisor is not scrambling for records at the last minute.

One Form Per Supervisor Per Setting

You need one experience verification form for every unique supervisor-and-employer combination.⁶ If you worked at two agencies under the same supervisor, that is two forms. Two supervisors at one agency? Also two. Most applicants end up submitting several.

Fill In the Hour Categories Correctly

The heart of the form is the hour breakdown. You and your supervisor report clinical activities in the specific categories printed on the form: individual supervision, triadic supervision, group supervision, direct client counseling, and other professional activities. Categories are not interchangeable, and totals need to reconcile against the 3,000-hour requirement.

Supervision hours also carry a weekly ratio. For AMFTs, the BBS requires at least one unit of supervision for every five hours of direct client contact in any week you performed clinical work. A unit is one hour of individual supervision (one-on-one), one hour of triadic supervision (one supervisor with two supervisees), or two hours of group supervision (one supervisor with up to eight supervisees). The ratio is calculated weekly, not averaged. Twenty hours of direct client contact in a week means four units of supervision that same week. Hours earned during weeks where the ratio was not met may not count.

The single most common problem the board sees is a mismatch between the applicant’s log and the supervisor’s numbers. Before your supervisor signs, compare your personal records against the form line by line. A discrepancy of a handful of hours can trigger a board inquiry, and resolving it after submission takes far longer than catching it beforehand.

The Supervisor’s Section, Signatures, and the Responsibility Statement

Your supervisor fills in the verification portion and attests to the hours and oversight they provided. That is separate from the Supervisor’s Responsibility Statement, which each supervisor must complete before supervision begins. The LMFT version is required under Title 16 CCR section 1833.1, and the LCSW version under section 1870.⁹¹⁰ Both are signed under penalty of perjury. Get the original signed copy from your supervisor at the start of supervision, not years later when you are assembling your application.

Signatures on the experience verification itself can be original, scanned, or electronic, according to the LCSW application instructions.¹¹ A photocopy of a signed page is not the same thing as a scanned original or an authenticated e-signature. When in doubt, have your supervisor sign through a recognized platform like Adobe Sign or DocuSign, or provide a scanned image of a wet-ink signature.

Video Supervision Counts

Supervision delivered through HIPAA-compliant videoconferencing is now permanently accepted by the BBS. It started as a pandemic-era accommodation and has since been written into the board’s regulations. Report video hours the same way you would in-person hours. The form does not require you to distinguish between modalities.

Submit It With the Rest of Your Application

The experience verification forms travel with the full licensure application package, not on their own. For LMFT applicants, the package includes the completed application (Form 37A-300), a $500 check or money order payable to the Behavioral Sciences Fund ($250 for application review plus $250 for the clinical exam, with the application portion non-refundable), all experience verification forms, a Supervisor Responsibility Statement or Supervision Agreement for each supervisor, proof of telehealth coursework, proof of suicide risk assessment and intervention training if not already on file, a W-2 or voluntary employment verification letter for each employer, a Live Scan form from each employer that required one, and a name-change notification if your legal name differs from what the board has.¹²

The LCSW fee structure is different: applicants pay $250 to the BBS, and the clinical exam fee is paid separately and directly to the Association of Social Work Boards, which administers the exam.¹¹ LPCC applicants should check the current LPCC application instructions for that license type’s fee breakdown.

Mail the package to the BBS office in Sacramento using a trackable service so you have proof of delivery. The current mailing address is on the BBS contact page.¹³ Keep a complete photocopy or scan of every page you send, including the checks.

What Happens After You Submit

Applications are reviewed in the order received. Processing times vary with filing volume, and the BBS does not publish a guaranteed turnaround. Plan for several weeks at minimum, and do not schedule your exam until you have written confirmation that your application has been approved. You can check status through the BBS BreEZe online system.

If the board finds a problem, such as a missing responsibility statement, mismatched totals, or an unsigned form, they send a deficiency notice explaining what needs to be corrected. A deficiency is not a denial. Respond quickly and precisely with exactly what the notice asks for. Once your application clears review, you are authorized to sit for the clinical licensing examination.

1
California Legislative Information. California Code BPC 4980.43 – Licensed Marriage and Family Therapists
2
California Legislative Information. California Code, Business and Professions Code – BPC 4996.23
3
Board of Behavioral Sciences. Professional Clinical Counselor In-State Experience Verification
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Board of Behavioral Sciences. Licensed Marriage and Family Therapist
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Board of Behavioral Sciences. Licensed Clinical Social Worker
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Board of Behavioral Sciences. Marriage and Family Therapist In-State Experience Verification
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Board of Behavioral Sciences. Experience Verification – Out-of-State or Out-of-Country
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Board of Behavioral Sciences. Clinical Social Worker In-State Experience Verification
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Board of Behavioral Sciences. Responsibility Statement for Supervisors of a Marriage and Family Therapist Trainee or Associate
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Board of Behavioral Sciences. Responsibility Statement for Supervisors of an Associate Clinical Social Worker
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Board of Behavioral Sciences. Licensed Clinical Social Worker Application for Licensure
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Board of Behavioral Sciences. Licensed Marriage and Family Therapist Application for Licensure
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Board of Behavioral Sciences. Contact Us – Board of Behavioral Sciences