AASECT Certified Supervisor Application

AASECT Certified Supervisor Application
Use the "Save" button at the bottom of the application to save and come back to your form as often as needed, with or without creating a Jotform account.

Please note: Drafts can only be saved for up to 2 months.

If you need assistance completing this form, please email certification@aasect.org.
Use the links below to review the requirements for each certification type:

Sexuality Counselor Supervisor | Sexuality Educator Supervisor | Sex Therapist Supervisor
About You
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 reside in or was educated 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/certification to practice. If you are not licensed (Counselors and Educators 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 - Professional Supervisor (Online fillable version)

Endorsement Form - Professional Supervisor (Downloadable PDF)

Professional Colleague Endorsement Form (Online fillable version)

Professional Colleague Endorsement Form (Downloadable PDF)
Primary Supervisor*

First NameLast Name
Primary Supervisor Email*
Please make sure this email address is accurate! Your application will be sent to your Supervisor at this email address for their review.
Primary Supervisor's Documentation
Please upload your Supervisor's certification and licensure from all jurisdictions. If your Supervisor is not licensed (Counselors and Educators 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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Endorsement letters must also be received from two professional colleagues who are able to evaluate the candidate's fitness for designation as a certified supervisor.
Please upload any other endorsement forms and recommendation letters from additional Supervisors.

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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 recommendation letters.*

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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).
Applicant Signature:*

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Date*

MonthDayYear
Date
Next Steps

Clicking the "Submit" button below will send your application to your Supervisor for their review (please confirm that their email address is accurate in the field above). Your supervisor will then have the option to either approve and submit your application to the AASECT office for processing, or they will be able to return your application to you if any edits are required.
Should be Empty:

AASECT Certified Supervisor Application

About You

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

Signature and Submission

Next Steps