Applications and Forms
 

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ONLINE APPLICATIONS

To apply for a certificate, license or endorsement with the Board:

  1. Navigate to the e-License Portal. The e-License Portal is most compatible with Google Chrome or the latest version of other internet browsers.

  2. Register/Login to your Dashboard and select the "Apply for a New License" link.

  3. You will be required to upload and attach all required forms. See forms below.

CHEMICAL DEPENDENCY COUNSELOR FORMS

CDCA FORMS

CDCA Preliminary (Phase I) Education Grid & Definitions
CDCA (Phase II) Education Grid & Definitions

LCDC II, LCDC III, LICDC FORMS

CD Education Grid
CD Education Definitions Page
Examination Waiver Form
Master's Degree Grid (For LIDC ONLY)
Master's Degree Content Areas Definition Page (For LIDC ONLY)
Practical Experience Verification Form
Reciprocal Certificate Form
Supervisor Reference Form

CLINICAL SUPERVISOR (CS) ENDORSEMENT FORMS

CS: Education Grid
CS: Education Definitions
CS: Supervisor Reference Form
Examination Waiver Form
Reciprocal Certificate Form

GAMBLING DISORDER ENDORSEMENT FORMS

GAMB Education Grid
GAMB Education Definitions
GAMB Experience Verification Form
GAMB Notification of Supervisory Relationship Form

PREVENTION PROFESSIONAL APPLICATIONS

RA APPLICATION AND FORMS

Professional Development Plan

OCPSA APPLICATION AND FORMS

OCPSA Education Grid
Prevention Education Definitions
Professional Development Plan
Supervisor Reference Form

OCPS I & II FORMS

Practical Experience Verification Form
Prevention Education Grid
Prevention Education Definitions
Supervisor Reference Form
Prevention Admin/Sup Education Grid (For OCPS II ONLY)
Prevention Admin/Sup Education Definitions
(For OCPS II ONLY)
Prevention Admin/Sup Supervisor Reference Form (For OCPS II ONLY)

 
 
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