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BBS
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STATE OF CALIFORNIA – BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY Gavin Newsom, Governor
Board of Behavioral Sciences
1625 North Market Blvd., Suite S200, Sacramento, CA 95834
Telephone: (916) 574-7830
www.bbs.ca.gov
MARRIAGE AND FAMILY THERAPIST TRAINEE / ASSOCIATE
WEEKLY SUMMARY OF EXPERIENCE HOURS
Name of Trainee/Associate: Last
Date enrolled in graduate degree program
Name of Work Setting (use a separate log for each)
Indicate your status when the hours below are logged: Trainee
Post-Degree / Associate Application Pending - BBS File No (if known): ________________
Registered Associate - AMFT Number: _______________
YEAR __________
A.
Direct Counseling
with Individuals,
Groups, Couples or
Families
*
A1.
and
Treatment of Couples,
Families, Children*
*
B.
-
***
Supervision, Individual
or Triadic
**
B2.
*
C.
Total Hours Per Week
(A + B = C)
****
Week of:
Week of:
Week of:
Week of:
Week of:
Total Hours
* Includes telehealth counseling.
** Line A1 is a sub-category of “A” and Lines B1 and B2 are subcategories of “B.” When totaling weekly hours do
NOT include the subcategories - use the formula found in box “C.”
*** Non-Clinical Experience includes: Supervision, psychological testing, writing clinical reports, writing progress
or process notes, client-centered advocacy, and workshops, seminars, training sessions or conferences.
**** A + B + C = Maximum 40 hours / week
37A-525 (Revised 01/2021)
