ARTICLE
V
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SUPERVISORS
QUALIFICATIONS
Q
UESTION YES NO
Are you able to demonstrate at least (2) two years of alcohol and drug abuse counseling experience?
Do you hold a current license for LCSW or MFT?
Have you completed the Board approved intern supervisor training?
If not on file with the Board please provide a current copy of the certificate.
Are you related to the applicant?
Are you involved in a close, personal relationship or friendship with the applicant?
Do you have or have you ever had a client relationship with the applicant?
Number of interns currently under your supervision?
Supervisors should be cognizant of the responsibility for supervising interns, please refer to NAC641C.285 for a detailed list of the supervisors duties. Supervisors may be subject
to disciplinary action by the board for non-compliance of supervisory duties and/or held civilly liable by the courts for the practice of interns under their supervision.
Supervisor should be available to consult with the Board about a certified intern being supervised by the licensed counselor concerning the record, competence in practice,
emotional and mental stability, and professional and ethical conduct of the certified Intern.
GENERAL PROVISIONS
This agreement supersedes any and all other agreements, oral or written, between Intern and Supervisor hereto with respect to the rendering of supervision of Intern by Supervisor.
This document contains all of the covenants and agreements between Intern and Supervisor with respect to representations, inducements, promises or agreements, orally or
otherwise, made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement, statement or promise not contained in the
agreement will be void.
Any modification of this agreement will be effective only if in writing, signed by Intern and Supervisor, submitted to and approved by the Board of Examiners for Alcohol, Drug
and Gambling Counselors. Such modifications must be in compliance with applicable Nevada Revised Statutes and Nevada Administrative Code and submitted within five days of
any changes. I understand the progress reports runs from January 1 until June 30 and July 1 until December 31 of each year, unless this is the first report. I understand
that all progress reports will be shared with future supervisors and the Board in the event that I apply to the Board for a different supervisor in the future.
I understand it is my responsibility to familiar with the Standards Practice and comply with them.
If any action at law or in equity, including an action for declaratory relief, is brought to enforce or interpret the provisions of this agreement, the prevailing party will be entitled to
reasonable attorney's fees, which may be set for that purpose, in addition to any other relief that the party may be entitled.