Vol. 37 Iss. 12 - February 01, 2021

Chapter 50

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.

Title of Regulation: 18VAC115-50. Regulations Governing the Practice of Marriage and Family Therapy.

Agency Contact: Elaine Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Henrico, VA 23233, telephone (804) 367-4688, FAX (804) 527-4434, or email

FORMS (18VAC115-50)

Licensure Application - Marriage and Family Therapist, MFT Form 2 (rev. 2/2011).

Verification of Licensure, MFT Form 2-VL (rev. 2/2011).

Verification of Supervision – Post-Graduate Degree Supervised Experience, MFT Form 2-VS (rev. 2/2011).

Licensure Verification of Out-of-State Supervisor, MFT Form 1-LV (rev. 2/2011).

Quarterly Evaluation, MFT Form 1-QE (rev. 2/2011).

Coursework Outline Form, MFT Form 2-CO (rev. 2/2011).

Verification of Internship, MFT Form 2-VI (rev. 2/2011).

Verification of Internship Hours Towards the Residency, MFT Form 2-IR (rev. 2/2011).

Supervision Outline - Examination Applicants Only, MFT Form 2-SO (rev. 2/2011).

Verification of Clinical Practice 5 of Last 6 Years Immediately Preceding Submission for Application of Licensure, Endorsement Applicants Only, Form MFT-ECP (rev. 2/2011).

Registration of Supervision - Post Graduate Degree Supervised Experience, MFT Form 1 (rev. 2/2011).

Application for Reinstatement of a Lapsed License (rev. 8/2007).

Continuing Education Summary Form (LMFT) (rev. 3/2009).

Applicant Out-of-State Licensure Verification/Certification (rev. 12/2019)

Request for Verification of Virginia Counseling License/Certification/Registration (rev. 5/2018)

Verification of Supervision for LMFT Licensure (rev. 12/2019)

Licensure Verification of Out-of-State Supervisor (rev. 12/2019)

Quarterly Evaluation for LMFT Licensure (rev. 12/2019)

Verification of Required Coursework and Internship for LMFT Licensure (rev. 12/2019)

Verification of Degree and Internship for LMFT Licensure (rev. 12/2019)

Doctoral Verification of Supervised Internship/Practicum Hours Toward LMFT Licensure (rev. 9/2019)

Supervision Summary Form for LPC Licensure (rev. 12/2019)

Termination of Supervision for a Licensed Resident (rev. 12/2019)

Verification of Clinical Independent Practice as a LMFT for 24 of the Last 60 Months Immediately Preceding Submission of Application for Licensure (rev. 5/2018)

Application for Board Approved LPC, LMFT and LSATP Supervisor (rev. 2/2020)

Application for Reinstatement of a LPC, LMFT, LSATP (rev. 4/2018)

Application for Reinstatement of a LPC, LMFT, LSATP Following Revocation or Suspension (rev. 4/2018)

Continuing Education Summary Form for LMFT (rev. 9/2019)

VA.R. Doc. No. R21-6621; Filed January 05, 2021