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 1000 Hour Supervision Evaluation 2016

1000 Hour Supervision Evaluation 2016

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Situation if yes give date CERTIFICATION AND SIGNATURE I certify the applicant named above obtained marriage and family therapy experience under my supervision while my license was in good standing. I am certifying the applicant completed total hours of marriage and family therapy work total of hours experience beginning on and ending on. Bureau of Professional Licensing PO Box 30670 Lansing MI 48909 Telephone 517 373-8068 www. michigan.gov/bpl bpldata michigan.gov SUPERVISOR S EVALUATION OF...
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