State of Louisiana

LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS

8631 SUMMA AVENUE

BATON ROUGE, LA 70809

Phone: 225-765-2515 C Fax: 225-7665-2514

Website: www.lpcboard.org

MARRIAGE AND FAMILY THERAPY INTERN TRANSCRIPT FORM

Applicant's Name ____________________________________________

For a description of the content areas, see Board Rules '3311(A) and (B). Please place each course in the content areas listed on this form.

Place the course number and title from your transcript on the line next to the content area. Please include a catalog course description, a copy of the course syllabus, or a letter from the professor who taught the course or a current professor at that university that documents the course content if the title of course does not match the content area title and needs an explanation. All courses listed must clearly be shown as graduate credit on the transcript or you will need additional documentation.

If needed, please use extra pages in the same format.

Academic Course Content

1. Applicants applying under §3309(A)(1)(a)--with a master's or doctoral degree from a COAMFTE-accredited marriage and family therapy program need to fill out this form.

2. Applicants applying under §3311(A)(9)--with a master's or doctoral degree from a CACREP-accredited marriage and family counseling/therapy program need to fill out this form, including listing the minimum six required courses in MFT/MFC in the appropriate academic course content area. Please write "none" if you have not had a course in an area.

3. Applicants applying under §3311(B)--with a Master's or Doctorate degree in a related mental health discipline) need to list all the courses required to meet the Standards for Marriage and Family Therapy Established by COAMFTE as determined by the Advisory Committee and Approved by the LPC Board.

You must verify that you have completed the required graduate coursework including the MFT practicum. A COAMFTE and Advisory Committee approved MFT practicum is required but does not count as coursework. You cannot practice in Louisiana outside of an academic setting unless you are registered as an intern with a licensing board or are licensed as a mental health professional. You would not have to be on campus but your supervision would have to be done as a part of your educational requirements.

Theoretical Knowledge of Marriage and Family Therapy—a minimum of 2 courses

1.  ____________________________________________________________

2.  _____________________________________________________________

Clinical Knowledge of Marriage and Family Therapy—a minimum of 4 courses

1.  ____________________________________________________________

2.  ___________________________________________________________

3.  ____________________________________________________________

4.  _____________________________________________________________

Assessment and Treatment in Marriage and Family Therapy—a minimum of 2 courses

1.  _____________________________________________________________

2.  ____________________________________________________________

Individual, Couple, and Family Development—a minimum of 1 course

1.  _____________________________________________________________

Professional Identity and Ethics in Marriage and Family Therapy—a minimum of 1 course

1.  ______________________________________________________________

Research—a minimum of 1 course

1.  ____________________________________________________________

Additional Learning—a minimum of 1 course

1.  ___________________________________________________________

Supervised MFT Clinical Practicum (Does not count as coursework)

500 supervised direct client contact hours with 100 hours of face-to-face supervision. At least 250 of these hours will be with couples or families present in the therapy room.

The training of the supervisor must be equivalent to that of an AAMFT approved supervisor or AAMFT supervisor candidate.

If a student is simultaneously being supervised and having direct client contact, the time may be counted as both supervision time and direct client contact time.

You will need a letter sent directly from your program that documents the hours in your supervised MFT clinical practicum

Updated February 2007