Skip to main content

Professional Counselor - Application Forms

Application for Professional Counselor 
Form # Title/Description
1962 Professional Counselor Licensing Application This includes Professional Counselor by Examination, Reciprocity, Temporary, and Training License.
1960 Professional Counselor Certificate of Professional Education Form Not required for Reciprocal License.
2239 Professional Counselor Curriculum Requirements Form  Required if degree is not in professional counseling or otherwise approved degree. 
2464 Affidavit of Applicant's Competencies - Documentation of Clinical Experience Gained Under Training License Supervisor Not required for Training License or Reciprocal License. 
2456 Professional Counselor Post-Graduate Supervisor Approval Form 
2921  Application to Renew Current Marriage and Family Therapist or Professional Counselor Training License  
2252 Convictions and Pending Charges
2829 Malpractice Suits or Claims Form (only needed if applicable)  
3071 Fax Payment Form 
Application for Psychometric Testing
Form # Title/Description
2579  Affidavit of Supervisor in Support of Application to Engage in Psychometric Testing 
2578  Application to Engage in Psychometric Testing 
Application for Substance Abuse Specialty 
Form # Title/Description
2711  Application for Substance Abuse Specialty Authorization  
2712  Affidavit Regarding Supervised Experience for Substance Abuse Specialty Authorization 
2714  Substance Abuse Specialty Authorization Education and Training Form (for master degree applicants)
2713  Substance Abuse Specialty Authorization Education and Training Form (for bachelor degree applicants)

Other Information/Forms

Professional Counselor - License Information