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             ​        Board Application Forms

  • Criminal History Records Check Information form will be mailed to you.
  • Pre-registration form. (This form will be mailed to you)
ALCOHOL AND DRUG TRAINEE APPLICATIONS
Alcohol Drug Trainee Application​     AD#1
Pre-Application Credentials Evaluation for Trainee     AD#2
Alcohol Drug Trainee Supervisor Information​     AD#3
Trainee Renewal Form​​​     AD#4

 

ALCOHOL AND DRUG APPLICATIONS
Alcohol and Drug CSC-AD Application     AD#5
Alcohol and Drug CAC-AD Application​     AD#6
LCADC Application​     AD#7
Alcohol Drug LGADC Application​​     AD#8
Pre Application Credentials Evaluation for CSC-AD​     AD#9
Pre Application Credentials Evaluation for CAC-AD​     AD#10
Pre-Application Credentials Evaluation for LCADC​     AD#11
Pre-Application Credentials Evaluation for LGADC​     AD#12
Licensed Clinical Alcohol and Drug Approved Supervisor​​     AD#13
Certified Alcohol and Drug Approved Supervisor​​​​     AD#14
ALCOHOL AND DRUG (OUT OF STATE APPLICATIONS)
OUT OF STATE CSC-AD​     AD#15
OUT OF STATE CAC-AD     AD#16
OUT OF STATE LCADC​     AD#17

 

PROFESSIONAL COUNSELOR APPLICATIONS
Pre-Application Credentials Evaluation for LGP     PC#1
LCPC Application​​​​​     PC#2
LGPC Application​     PC#3
Transfer from LGPC to LCPC​​​​​     PC#4
Supervised Clinical Documentation Form     PC#5
Educational requirement information for LCPC and LGPPC     PC#6
LGPC Supervision Requirements Regulation     PC#7
Approved Supervisor Application for LCSW-C, Psychiatrists, Psychologists, and  Psychiatric Nurse Practitioners​​     PC#8
Professional Counselors Approved Supervisor Application     PC#9
Professional Counselors Contract for Supervision     PC#10
For LGPC's - Sample Professional Disclosure Statement​      PC#11
LCPC (OUT OF STATE APPLICATIONS)
Instructions LCPC​     PC#12
Out Of State Board Application Form​​     PC#13
Out Of State Verification Form     PC#14
Education Requirements     PC#15
Course Form     PC#16
VERIFICATION FORM MASTERS DEGREE LESS THAN 60 CREDITS OR 90 QUARTER CREDITS     PC#17
VERIFICATION FORM MASTERS DEGREE WITH 60 CREDITS     PC#18
VERIFICATION FORM FOR DOCTORAL DEGREE     PC#19
MARRIAGE AND FAMILY THERAPY
Pre-Application Credentials Evaluation for LCMFT​
LCMFT Application​
LGMFT Application​
Transfer from LGMFT to LCMFT​​​
LCMFT (OUT OF STATE APPLICATIONS)
Instructions LCMFT
Out Of State Board Application Form for LCMFT​
Out Of State Verification Form​
Course Form
VERIFICATION FORM MASTERS DEGREE LESS THAN 60 CREDITS OR 90 QUARTER CREDITS
VERIFICATION FORM MASTERS DEGREE WITH 60 CREDITS
VERIFICATION FORM FOR DOCTORAL DEGREE

 

ART THERAPY APPLICATIONS
Licensure Application​
Licensed Graduate Professional Art Therapists (LGPAT)​

MISCELLANEOUS FORMS
Name Change
Duplicate License Request​
Application for Inactive Licensure / Certification Status​
Address Change​​
Verification Request Form​
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