Section Alc 313.05 - Report Form Documenting Hours of Supervised Practical Training in Alcohol and Drug Counseling The report form "Supervised Practical Training Report Form" documenting receipt of hours of supervised practical training in alcohol and drug counseling shall require:
(a) The information detailed in (b) below to be reported separately for each site of internship, academic program, supervision site, or supervised experience where the applicant received supervised practical training; and(b) The following information shall be provided on the "Supervised Practical Training Report Form": (1) The name of the internship, academic program, or work site where the applicant received supervised practical training in alcohol and drug counseling;(2) The number of hours of supervised practical training received by the applicant in each of the following 12 core functions:k. Reporting and record keeping; and (3) The total hours of supervised practical training in alcohol and drug use counseling;(4) A certification that the total number of hours of supervised practical training included a minimum of 10 hours of supervised practical training in each of the 12 core functions;(5) The name(s) and title(s) of the individual(s) providing the supervised practical training or their replacements if the supervisors are no longer available;(6) The signature(s) of such individual(s) or, if such individual is no longer employed at the same location, of an individual who can attest that the supervised practical training was completed; andN.H. Admin. Code § Alc 313.05
Derived From Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12001, Effective 10/13/2016, Expires 10/13/2026.Amended by Number 6, Filed February 9, 2023, Proposed by #13518, Effective 3/13/2023, Expires 3/13/2033 (see Revision Note at chapter heading for Alc 300).