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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 86. State Board of Behavioral Health Licensure |
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Chapter 15. Licensed Marital and Family Therapists |
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Subchapter 5. Application for Licensure |
SECTION 86:15-5-4. Additional forms
Latest version.
- (a) Licensure Verification Request Form - name of licensee; licensee license number; and licensee license type.(b) Out-of-State License Verification Form - identifying information; type of credential held in other state; license number; issue and expiration date of license; current standing of license; past complaints or sanctions; exam information; supervision information; graduate education; internship documentation; signature and identifying information of person verifying from out-of-state.(c) Mailing Addresses Request/Order Form - type of licensure list requested; format requested; identifying information of person making request.(d) Licensure Reactivation Request Form - licensure type, identifying information; employment information; graduate education; license type and number; dates of inactivation and reactivation of license.(e) LMFT Continuing Education Approval Application Form - name of workshop; program context; program knowledge area; name of presenter; presenter qualifications; date of presentation; number of hours requested; sponsoring agency; name of contact; phone number of contact; signature and signature date of contact; program content in relation to mental health ethics; program content in relation to therapy supervision; number of hours requested for mental health ethics; number of hour requested for therapy supervision.(f) The Termination of Supervision Agreement requires the following information:(1) name of candidate;(2) current place of employment of candidate;(3) address of current place of employment of candidate;(4) phone number of candidate;(5) email address of candidate;(6) signature and signature date of candidate, (if available);(7) name of supervisor;(8) license number of supervisor;(9) current place of employment of supervisor;(10) phone number of supervisor;(11) email address of supervisor;(12) signature and signature date of supervisor, (if available); and(13) effective date of termination of supervision agreement.