Renewal Forms

If you cannot download the forms below, or you do not have a computer, you can print off forms from a computer at your local library. You may also mail, call 614-466-0912 or e-mail your request for forms. Be sure to include the following information.
Name & Address & City/State/Zip & if you have one your License Number.

The Adobe Reader is required to view these forms. Versions for Windows, DOS, Macintosh or Unix are available FREE. Forms are Active Adobe Forms meaning you can click on the text boxes and type in your information and then print for mailing.

Counselor Forms

Out-of-State applicant information

In-State 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).
CT & CR Paper Registration Application & Supervision Agreement - For Counselor Trainee (CT) or Clinical Resident (CR) to register their clinical supervisor (CT/CR 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.
CR to update or change “Supervision Agreement” - For Clinical Resident (CR) to update or change information affecting their existing registration (CR email changes to board).
Supervision Evaluation & Verification - For evaluation of PC working under PCC supervision as a clinical resident to document hours.
Clinical Field Evaluation - For Clinical Residnet to obtain supervisor evaluation (at completion of 3000 hours of supervision).

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).