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State of Nevada Board of Examiners
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Adopted Regulations - R163-12A - Effective June 23, 2014 (pdf)
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Internship Forms & Reports
Marriage & Family Therapist
Primary Six-Month Internship Report (Form #1)
Secondary Six Month Internship Report (Form #2)
MFT Intern Final Internship Report (Form #3)
When submitting an MFT-Intern Final Internship Report: Form 3, also submit along with it a Primary Six Month Internship Report: Form 1 and a Secondary Report: Form 2.).
Clinical Professional Counselors
Primary Six Month Internship Report (Form #4)
Secondary Six Month Internship Report (Form# 5)
CPC-Intern Final Internship Report (Form# 6)
When submitting a CPC-Intern Final Internship Report: Form 6, also submit along with it a Primary Six Month Internship Report: Form 4 and a Secondary Report: Form 5.
Other Forms
Internship Extension Form
Practicum Internship Report from University Supervisor (Form #7)
Supervisor & Intern Dissolution Form
To be submitted with the Application or anytime during the internship
MFT Exam Request Form
CPC Exam Request Form
Supervision Forms
Primary Supervisory Internship Proposal
Secondary Supervision Contract Form
Licensed Mental Health Professional Available for Consultation