Counselor Forms

PC, PCC & CT Applicants review applicant information below

PC-PCC Out-of-State applicant information

PC-PCC In-State applicant information

CT applicant information

Professional Counselor Forms:
PC Licensure Exam Guide for Graduates of Ohio Schools
PC Examination/Application Request
Course Worksheet - For applicants from non-Ohio programs to list all courses in each subject area with explanation pages.
PC Professional Disclosure Statement
Supervision Designation Application - For PC to apply online for supervision designation.
Supervision Designation Application - For PC to apply on paper for supervision designation.
Internship Supervision Evaluation - For counseling interns to obtain supervisor evaluation of intern (one form required for each supervisor and/or location w/i 30 days of completion).
Practicum Report - No longer required.

Counselor Trainee & Clinical Resident Forms:
CR Online Registration Application & Supervision Agreement - For Clinical Resident (CR) to apply for registration and document their initial clinical supervisor (CR complete application & supervisor is emailed to complete process).
CR Paper Registration Application & Supervision Agreement - For Clinical Resident (CR) to register their clinical supervisor (CR fills in their part & provides to supervisor to complete and submit).
CT Initial Registration Application & Supervision Agreement - For Counselor Trainee (CT) to register their clinical supervisor (CT fills in their part & provides to supervisor to complete and submit).
CT Extension - For Counselor Trainee (CT) to update or change information affecting their existing registration.
Supervision Evaluation & Verification - For evaluation of PC working under PCC supervision as a clinical resident to document hours.
Clinical Field Evaluation - For Clinical Resident to obtain supervisor evaluation (at completion of 1,500 and 3,000 hours of supervision). You must have two full years of supervision documented.

Professional Clinical Counselor Forms:
PCC Examination/Application Request
PCC Professional Disclosure Statement
Supervision Designation Application - For PCC to apply online for supervision designation.
Supervision Designation Application - For PCC to apply on paper for supervision designation.

Combined PC & PCC Forms:
Criminal Records Check Information - For obtaining a Criminal Records Check
NBCC Licensing Exam Info - NCE & NCMHCE examination information.
Ohio Examination Info & Handbook - NBCC Exam page for Ohio.
CEU Post program approval forms - Counselors - For obtaining approval of CEU bearing activities which do not have prior Board approval.
Name Change/Replace Wall Certificate - For registering marriage, divorce, or other name changes; for replacing lost or mutilated Wall Certificates.
Address Change - Online - For registering all address changes (must be submitted w/i 30 days of change. You will need a User ID and Password: email or call Board if you need them).
Address Change - Paper - For registering all address changes (must be submitted w/i 30 days of change; print to fax, mail or scan to email).
Out-of-State License Verification - request for license verification.
Out-of-State coursework documentation - for out-of-state applicants to document coursework.
License Verification - To verify all Board licensees (searchable database).

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