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CED684 Internship Application & Letter of AgreementJuly 18th, 2016
Internship Site Name Address City State ZIP Type of Agency Site Supervisor** AZ License # name and highest degree Preferred Phone Alternate Phone Email **According to state licensure requirements, behavioral health supervisors must be licensed in Arizona at the independent level with a master or higher degree. Exemptions may be granted by AZBBHE on a case by case basis after a thorough review of the education, training & experience of the proposed supervisor. After July 1, 2006 no exemptions will be granted for an unlicensed clinical supervisor providing clinical supervision by the AZBBHE. In the interim, ASU retains the right to decline internship supervision by a supervisor unlicensed in Arizona.
