Certified Supervisor Application

AASECT Certified Supervisor Application
Attention: This is an outdated version of the Certified Supervisor Application. We strongly encourage you to use only the new version of the application, which can be found here: AASECT Certified Supervisor Application.

Please contact certification@aasect.org with any questions.

Use the "Save" button at the bottom of the application and then select "Skip Create an Account" to save and come back to your form as often as needed. Please DO NOT create an account when saving your form, or you will not be able to share the form with your Supervisor for their signature.

Use the links below to review the requirements for each Certification type:

Sexuality Counselor Supervisor | Sexuality Educator Supervisor | Sex Therapist Supervisor
Applicant Information
Name*

First NameMiddle Name or initial (optional)Last Name
Other names for me that may appear on my application.

First NameMiddle NameLast Name
Pronouns (optional)
Credentials (optional)
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Telephone*
AASECT membership.*
Certification requirement: I verify that I currently practice or I am eligible to practice, and that my education is recognized in the United States, Canada, Mexico, or Israel.*

Yes
Please indicate which Supervision Certification you are pursuing.*
Code of Conduct
Review: AASECT Code of Conduct for Members
Have you ever been disciplined for professional or ethical misconduct?*

YesNo
Is any action pending against you for professional or ethical misconduct?*

YesNo
If you answered "Yes" to either of the above two questions, please provide more detail here.
I have read and understood the AASECT Code of Conduct for (CoC) for Certified Members. I understand the CoC and I agree to adhere to the CoC. *

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Required Documents
Licensure and/or Certification
Please upload your professional license and/or certificate to practice. If you are not licensed (Educators and Counselors only), please skip this item.

This can be a photo of a physical card or a screenshot of your verification page on your licensing board website. It must show the expiration date.
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Work Experience
Please upload your current résumé or CV.*

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Summary of Supervision

Supervisors-in-training must work with a minimum of 2 supervisees prior to certification
Please provide a written summary of your supervision of at least one of your supervisees. Include in your summary your perception of supervisory roles and relationships, power and privilege, specific concepts as it relates to your case discussion, contextual factors regarding diversity and inclusion, and ethical factors involved in the supervisory process.*

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Supervision and Endorsement Forms
Supervision and Endorsement Forms:

Endorsement Form - AASECT Supervisor (Online fillable version)

Endorsement Form - AASECT Supervisor (Downloadable PDF)

Certificate of Endorsement - Professional Colleague (Online fillable version)

Certificate of Endorsement - Professional Colleage (Downloadble PDF)
Primary Supervisor*

First NameLast Name
Primary Supervisor Email*
example@example.com
Primary Supervisor's Documentation
Please upload your Supervisor's certification and licensure from all jurisdictions. If your Supervisor is not licensed (Educators and Counselors only), please skip this item.

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Additional Supervisor(s)
If you had any additional Supervisors, please list their names here.
The documents and endorsement forms can be uploaded below.
Please upload the required documents (certification and licensure) for any additional Supervisors, including those of Short Duration (6 hours or less).

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Endorsement Forms
Please upload the Endorsement Form and letter of recommendation from your Primary Supervisor*

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Please list the names of the two (2) professional colleagues who have provided recommendation letters.*
The letters and endorsement forms will be uploaded below.
Please upload two (2) Professional Colleague Endorsement Forms and letters of recommendation. Letters must be submitted by colleagues with no financial or supervisory/supervisee relationships, or employment attachments.*

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Attention Applicant:

Please use the "Save" button at the bottom of the application and then select "Skip Create an Account" to get a shareable link that can be used to send your application to your Primary Supervisor for their review and signature. Please DO NOT create an account when saving the form, or you will not be able to share the form with your Supervisor for their signature.
Supervisor Signature
Primary Supervisor*

First NameLast Name
Primary Supervisor Signature: "I have reviewed and approved this application for AASECT Certification."*

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Attention Supervisor:

Please use the "Save" button at the bottom of the application and then select "Skip Create an Account" to get a shareable link that can be used to send the application back to your Supervisee for their signature and submission. Please DO NOT create an account when saving the form, or you will not be able to share the form with your Supervisee.
Signature and Submission
In signing this application, I attest that: 1. All pages of the application form are completed in English. 2. All endorsement forms, transcripts and other relevant supporting documentation are attached in the appropriate areas 3. I agree to pay the non-refundable application fee of $300.00 (payment instructions will be sent by email from the AASECT Certification Staff once this application is received). *

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AASECT Certified Supervisor Application

Applicant Information

Code of Conduct

Required Documents

Licensure and/or Certification

Work Experience

Summary of Supervision

Supervision and Endorsement Forms

Primary Supervisor's Documentation

Additional Supervisor(s)

Endorsement Forms

Attention Applicant:

Supervisor Signature

Attention Supervisor:

Signature and Submission