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 elaine.yeatts@dhp.virginia.gov.

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)