Certificate of Endorsement - Professional Supervisor

Certificate of Endorsement - Professional Supervisor

This form can be used for Supervisors that provided any amount or type of supervision to the applicant. Please note that some sections indicate that they are required for the applicant's PRIMARY Supervisor.
If you need assistance completing this form, please click here to complete the Certification Application Feedback/Troubleshooting Form.

You can also contact us at certification@aasect.org.
Applicant's Name*
Supervisor's Name*
I endorse this applicant as a:*
Please select your current status with AASECT:*

I am currently an AASECT Certified Sexuality EducatorI am currently an AASECT Certified Sexuality CounselorI am currently an AASECT Certified Sex TherapistI am currently an AASECT Certified Supervisor
I have known the applicant for number* years.
I supervised the applicant from (start date and end date)*
Start date to end date
If you were the applicant's Primary Supervisor - I supervised the Candidate for (enter number below) hours per month.
Hours per month
The total number of supervision hours completed was:*
Total hours
The setting(s)for the supervision provided was/were:*
Primary Supervisor - The applicant performed # hours of under my supervision.
If you were the applicant's Primary Supervisor - List the types of sexuality education, sexuality counseling, or sex therapy that were provided by the Candidate.
For best results, list types separated by a comma, not on separate lines.
By signing this form, I certify that:
- My applicable license and/or certificate(s) have been current and in good standing throughout the supervisory term.
- I reviewed the applicable license and/or certificate(s) of the applicant and found them to be in good standing throughout the supervisory term.
- If I provided more than 5 hours of supervision to this applicant, that I have provided them with a letter of endorsement highlighting my experience as the professional Supervisor of the applicant, the nature of our professional relationship, and my overall impressions of their strengths, competencies, and readiness to be certified, as well as any challenges that may impair competence.
Name *
Title*
Address (Street)*
Address (City, State, Zip/Postal, Country)*
Telephone*
Email*
example@example.com
Signature*

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Date*

MonthDayYear
Date
Please use the "Preview PDF" button below to download or print a copy of your completed form. Provide that form to the applicant to include with their AASECT Certification application.
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