Here's a much better version of the California Board of Behavioral Sciences MFT Experience Verification Form 37A-301a For Hours Gained ON or AFTER January 1, 2010.
Click on the "Download" link in the upper left corner to download the PDF.
This one is actually editable in Acrobat, so you can type your information right into the spreadsheet.
I don't know why they don't do this kind of thing to the forms on their website. I guess it takes a bit of extra time, but it sure would save everyone trouble.
The URL is: http://docs.google.com/fileview?id=0B6DUDITRID-cYzQwYzBhYzYtMjNkNS00YTBlLThiMmQtM2Q0NTlkYWM2ZjM0&hl=en