HourSign
Start free

Florida clinical experience verification (DH⁠-⁠MQA 1181)

The Florida board form that carries your registration and your supervised clinical experience details when you apply for the license.

Form
DH-MQA 1181
Board
Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling
Source checked
16 September 2026

What this form is.

  • A summary form, not a log. The totals and dates go here; the day-by-day detail stays in your supervision log.
  • It asks who you are, which license you are applying for, when your experience started, and your registration dates.
  • It also asks where you practised and who supervised you.

Who signs it

You and your qualified supervisor. Florida accepts electronic signatures on its board forms under chapter 668, part I of the Florida Statutes, but check the current form for its own signature instructions.

Common mistakes.

Most are easy to catch while the work is fresh.

  • Totals on this form that do not match the totals in your supervision log. Boards compare them.
  • Leaving the registration dates blank. Florida ties the start of countable experience to your intern registration.
  • Filing it before your supervisor has checked the numbers.

How HourSign fills it in.

  • HourSign prints a field sheet with the values it already holds: your name, the license you are working towards, your pathway, the date experience started, and your registration dates.
  • Practice settings and supervisors come from your own records, so you copy across instead of retyping.
  • Recorded hours and valid hours are printed side by side.

HourSign's page is not the board's form. It carries the board's layout so the numbers can be copied across, or so the page can be stapled behind the board's own copy. Every page says so.

The Exports screen in HourSign: signed direct and supervision totals, and a Board forms panel offering the Washington DOH 670-036 verification as a PDF, with a reminder to check the board's current form before submitting.
Board forms sit on the Exports screen, ready to download. Demo account.

The official source.

Last checked 16 September 2026

Florida Board 491 clinical experience verification (clinical-exp-verification.pdf)

Where we are not sure. Our research found this form published under two names: a registration form and a verification of clinical experience. We have not settled which name the board currently uses for number 1181. Open the board's forms page and match the number on the PDF before you fill anything in.
Check the board first. Check the board's own site for the current version of this form before you file anything. Boards change forms without notice, and the board's copy always wins over ours.

Other board forms.

Your hours, already in the board's layout.

Log free, forever. Your first signed period is free too. Supervisors never pay.

Start free See how it works