Applications and Forms
 

Home
 
Accreditation
Applications and Forms
Audit and CE Tracking
Board Meetings
Continuing Education
Ethics/Enforcement
Examination Process
Gambling Endorsement
Laws & Rules
Licensing
Licensure Verification
Military Benefits
Minutes
Prevention Certification
Publications
Reciprocity
Renewal
The Board
Contact Us

  • CHEMICAL DEPENDENCY COUNSELOR APPLICATIONS

CDCA APPLICATION AND FORMS

Phase I CDCA Application & Checklist
Phase II CDCA Application & Checklist

LCDC II APPLICATION AND FORMS

LCDC II Application & Checklist
Supervisor Reference Form
Practical Experience Verification Form
CD Education Grid
CD Education Definitions Page
Reciprocal Certificate Form

LCDC III APPLICATION AND FORMS

LCDC III Application & Checklist
Supervisor Reference Form
Practical Experience Verification Form
CD Education Grid
CD Education Definitions Page
Reciprocal Certificate Form
Examination Waiver Form

LICDC APPLICATION AND FORMS

LICDC Application & Checklist
Supervisor Reference Form
Practical Experience Verification Form
CD Education Grid
CD Education Definitions Page
Master's Degree Grid
Master's Degree Content Areas Definition Page
Reciprocal Certificate Form
Examination Waiver Form

LICDC-CS APPLICATION AND FORMS

LICDC-CS Application & Checklist
Supervisor Reference Form
Practical Experience Verification Form
CD Education Grid
CD Education Definitions Page
Master's Degree Grid
Master's Degree Content Areas Definition Page
Clinical Supervision: Supervisor Reference Form
Clinical Supervision: Education Grid
Clinical Supervision: Education Definitions
Reciprocal Certificate Form
Examination Waiver Form

CONVERSION APPLICATION AND FORMS

Conversion Application
Master's Degree Grid
Master's Degree Content Areas Definition Page
Clinical Supervision: Supervisor Reference Form
Clinical Supervision: Education Grid
Clinical Supervision: Education Definitions
Reciprocal Certificate Form
Examination Waiver Form

GAMBLING DISORDER ENDORSEMENT APPLICATION AND FORMS

Gambling Disorder Endorsement Application
GAMB Education Grid
GAMB Education Definitions
GAMB Experience Verification Form
GAMB Notification of Supervisory Relationship Form

  • PREVENTION PROFESSIONAL APPLICATIONS

RA APPLICATION AND FORMS

RA Application
Professional Development Plan

OCPSA APPLICATION AND FORMS

OCPSA Application & Checklist
Professional Development Plan
Supervisor Reference Form

OCPS I APPLICATION AND FORMS

OCPS I Application & Checklist
Practical Experience Verification Form
Prevention Education Grid
Prevention Education Definitions
Supervisor Reference Form

OCPS II APPLICATION AND FORMS

OCSP II Application & Checklist
Practical Experience Verification Form
Prevention Education Grid
Prevention Education Definitions
Supervisor Reference Form
Prevention Admin/Sup Education Grid
Prevention Admin/Sup Education Definitions
Prevention Admin/Sup Supervisor Reference Form

CONVERSION APPLICATION FORMS

Conversion Application and Checklist
Administrator/Supervisor: Supervisor Reference Form
Administrator/Supervisor: Education Grid

  • ETHICS/CONVICTION FORMS

Ethics Complaint Form
Felony Questionnaire
Misdemeanor Questionnaire
CD Code of Ethics
Supervisor Code of Ethics
Prevention Code of Ethics

  • RENEWAL FORMS

FOR CHEMICAL DEPENDENCY PROFESSIONALS

Renewal Application
International Certificate Order Form
Inactive Status Request Form

FOR PREVENTION PROFESSIONALS

Renewal Application
International Certificate Order Form
Inactive Status Request Form

  • EXAMINATION FORMS

Study Guide Order Form
Examination Order Form
Examination Waiver Form

  • MISC. FORMS

Inactive Status Request Form
Credit Card Authorization Form
Twelve Core Function Definitions
Reciprocal Certificate Application

 
Home