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Virginia Board of Counseling
Applications and Instructions

 

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Qualified Mental Health Professional (QMHP) and Registered Peer Recovery Specialists (RPRS)

QMHP – Adult

Please click here to review the Application Handbook.

Click here to begin the QMHP-A Initial Application: This application type is for individuals who have completed the required education and supervised experience with adults with mental illness as defined in the Regulations.

QMHP – Child

Please click here to review the Application Handbook.

Click here to begin the QMHP-C Initial Application: This application type is for individuals who have completed the required education and supervised experience with children and adolescents with mental illness as defined in the Regulations.

Qualified Mental Health Professional Trainee

Please click here to review the Application Handbook.

Click here to begin the QMHP-Trainee Initial Application: This application type is for individuals who wish to start accruing supervised experience towards QMHP-A and/or QMHP-C.

Registered Peer Recovery Specialists

Please click here to review the Application Handbook.

Click here to begin the RPRS Initial Application: This application type is for individuals who hold a CPRS certificate from VCB, NCPRSS from NAADAC, current and valid Peer Recovery Specialist certification from another state that was accepted by DBHDS or certified by the Veterans Administration as a Peer Recovery Specialist and has completed the DBHDS Peer Recovery Specialist Training.

Additional QMHP Forms

(The forms below are to supplement the online application and do not include the instructions. All forms and instructions are to be printed during the online application process. To complete the online application process, you must complete the online application in its entirety, submit the online fee and print out the instructions and supplemental documentation. Supplemental documents should be mailed to the Board in one packet. Documents without the online application will not be reviewed or considered.)

QMHP-A Verification of Supervised Experience (Supplemental documentation for QMHP-A Application)

QMHP-C Verification of Supervised Experience (Supplemental documentation for QMHP-C Application)

Verification of Internship/Practicum for QMHP (Supplemental documentation for QMHP-A and QMHP-C Application)

Reinstatement Application - Qualified Mental Health Professional-Adult

Reinstatement Application - Qualified Mental Health Professional-Child

 

Certified Substance Abuse Counselors

CSAC and CSAC-A Certification Process Handbook (PDF file)

Application Packet for CSAC Initial Registration of Supervision (PDF file)

Sample of a CSAC Supervisee Supervisory Contract (MS Word document)

Application for CSAC Add/Change Registration of Supervision (PDF file)

Application Packet for CSAC by Examination (PDF file)

Application Packet for CSAC by Endorsement (PDF file)

Reinstatement Application for Certified Substance Abuse Counselors (PDF file)

Substance Abuse Counselor or Counseling Assistant Application for Reinstatement of Certificate Following Revocation or Suspension (PDF file)

Additional CSAC Forms

Verification of Clinical Supervision Form for CSAC Certification

Didactic Training Verification Form for CSAC Certification

Request for Termination of Supervision Form

Request for Verification of VA License or Certification Form

Out of State License or Certification Verification Form

Supervisor Out of State License or Certification Verification Form

 

Certified Substance Abuse Counselor Assistants

CSAC and CSAC-A Certification Process Handbook (PDF file)

Application packet for Certified Substance Abuse Counselor Assistant (PDF file)

Reinstatement Application for Certified Substance Abuse Counselor Assistant (PDF file)

Substance Abuse Counselor or Counseling Assistant Application for Reinstatement of Certificate Following Revocation or Suspension (PDF file)

Additional CSAC-A Forms

Verification of Experience Form for CSAC-A Certification

Didactic Training Verification Form for CSAC-A Certification

Request for Verification of VA License or Certification Form

 

Licensed Professional Counselors

LPC Licensure Process Handbook (PDF)

Sample of a Resident in Counseling Supervisory Contract (MS Word document)

Temporary License as a Resident in Counseling

Click here to begin the Resident in Counseling License Application: This application type is for individuals who have met the degree and coursework requirements outlined in the Regulations, have a qualified supervisor willing to supervise your experience and worksite where you can provide clinical counseling services.

Licensed Professional Counseling (LPC) by Examination Application

Click here to begin the LPC by Examination Application: This counseling licensure application type is for individuals who are have met the degree and coursework requirements, completed all residency requirements and have pass the NCMHCE examination as outlined in the Regulations.(If you hold an equivalent license, please apply by endorsement.)

 

Licensed Professional Counseling (LPC) by Endorsement Application

Click here to begin the LPC by Endorsement Application: This counseling licensure application type is for individuals who hold or have held an equivalent professional counseling license for independent clinical practice in another U.S. jurisdiction.

Application Packet for Pre-Review of Education toward LPC Licensure (PDF)

Reinstatement Application Packet for Licensed Professional Counselors (PDF)

Application Packet for Reinstatement of a Revoked or Suspended License (PDF)


Additional LPC Forms

Verification of Coursework Form for LPC Licensure (PDF)

Verification of Degree and Internship Form for LPC (PDF)

Supervisor Out of State License or Certification Verification Form (PDF)

Verification of Supervision Form for LPC Licensure (PDF)

Quarterly Evaluation Form for LPC Licensure (PDF)

Supervision Summary Form for LPC Licensure (PDF)

Request for Termination of Supervision Form (PDF)

Out of State License or Certification Verification Form (PDF)

Verification of Clinical Practice for 24 of the Last 60 Months for LPC Licensure (PDF)

Request for Verification of VA License or Certification Form (PDF)

Doctoral Verification of Internship/Practicum for LPC (PDF)

 

Supervisor Approval Applications

Supervisor Approval Application for LPC, LMFT and LSATP (PDF file)

Supervisor Approval Application for CSAC and CSAC-A (PDF file)

 

Licensed Substance Abuse Treatment Practitioners

Sample of a Resident in Substance Abuse Treatment Supervisory Contract (MS Word document)

Temporary Licensed as a Resident in Substance Abuse Treatment

Click here to begin the Resident in Substance Abuse Treatment License Application: This application type is for individuals who have met the degree and coursework requirements outlined in the Regulations, have a qualified supervisor willing to supervise your experience and worksite where you can provide substance abuse treatment services.

 

Licensed Substance Abuse Treatment Practitioner (LSATP) by Examination Application

Click here to begin the LSATP by Examination Application: This substance abuse treatment practitioner licensure application type is for individuals who are have met the degree and coursework requirements, completed all residency requirements and have pass the MAC examination as outlined in the Regulations.

 

Licensed Substance Abuse Treatment Practitioner (LSATP) by Endorsement Application

Click here to begin the LSATP by Endorsement Application: This substance abuse treatment practitioner licensure application type is for individuals who hold an equivalent license in another state, or otherwise meet the requirements for endorsement as outlined in Regulations 18VAC115-60-50.

Application Packet for Pre-Review of Education toward LSATP Licensure (PDF)

Reinstatement Application for Licensed Substance Abuse Treatment Practitioners (PDF file)

Application Packet for Reinstatement of a Revoked or Suspended License (PDF file)

Additional LSATP Forms

Quarterly Evaluation Form for LSATP Licensure (PDF file)

Supervision Summary Form for LSATP Licensure (PDF file)

Verification of Supervision Form for LSATP Licensure (PDF file)

Verification of Required Coursework for LSATP Licensure (PDF file)

Verification of Degree and Internship (PDF file)

Supervisor Out-of-State License or Certification Verification Form (PDF file)

Out of State License or Certification Verification Form (PDF file)

Request for Termination of Supervision Form (PDF file)

Request for Verification of VA License or Certification Form (PDF file)

Verification of Post-Licensure Active Practice Form (PDF file)

 

Certified Rehabilitation Providers

General Information for Certification as a Rehabilitation Provider (Word .doc)

Memo regarding Applications (Word .doc)

Frequently Asked Questions (Word .doc)

Application for Certification as a Rehabilitation Provider (PDF file)

Verification of Experience for Rehabilitation Provider Certification (PDF file)

Supervisor Out-of-State Licensure or Certification Form (PDF file)

Out of State License or Certification Verification Form (PDF file)

Rehabilitation Provider Application for Reinstatement of a Lapsed Certificate (PDF file)

 

Marriage and Family Therapists

LMFT Licensure Process Handbook (PDF file)

Sample of a Resident in Marriage and Family Therapy Supervisory Contract (MS Word document)

Temporary Licensed as a Resident in Marriage and Family Therapy

Click here to begin the Resident in Marriage and Family Therapy License Application: This application type is for individuals who have met the degree and coursework requirements outlined in the Regulations, have a qualified supervisor willing to supervise your experience and worksite where you can provide marriage and family therapy services.

 

Licensed Marriage and Family Therapy (LMFT) by Examination Application

Click here to begin the LMFT by Examination Application: This marriage and family therapy licensure application type is for individuals who are have met the degree and coursework requirements, completed all residency requirements and have pass the National MFT examination as outlined in the Regulations. (If you hold an equivalent license, please apply by endorsement.)

 

Licensed Marriage and Family Therapy (LMFT) by Endorsement Application

Click here to begin the LMFT by Endorsement Application: This marriage and family therapy licensure application type is for individuals who hold or have held an equivalent marriage and family therapy license for independent clinical practice in another U.S. jurisdiction.

Application Packet for Pre-Review of Education toward LMFT Licensure (PDF)

Reinstatement Application for Marriage and Family Therapist (PDF file)

Application Packet for Reinstatement of a Revoked or Suspended License (PDF file)

Additional LMFT Forms

Verification of Supervision Form for LMFT Licensure (PDF file)

Quarterly Evaluation Form for LMFT Licensure (PDF file)

Verification of Clinical Practice for 24 of the Last 60 Months for LMFT Licensure (PDF file)

Supervision Summary Form for LMFT Licensure (PDF file)

Verification of Coursework for LMFT Licensure (PDF file)

Verification of Internship form for LMFT Licensure (PDF file)

Supervisor Out of State License or Certification Verification Form (PDF file)

Out of State License or Certification Verification Form (PDF file)

Request for Termination of Supervision Form (PDF file)

Request for Verification of VA License or Certification Form (PDF file)

Doctoral Verification of Internship/Practicum for LMFT Licensure (PDF file)

 

 

Continuing Education Forms

Continuing Education Summary Form - LPC (Word .doc)

Continuing Education Summary Form - LMFT (Word .doc)

Continuing Education Summary Form - LSATP (Word .doc)

Formal Staffing Attendance Form (Word .doc)

Form for Reporting Counseling Independent Study (Word .doc)

 

Compliance Forms & Information

Compliance FAQs

Initial Contact Form

Approval Request Forms

CE and Education Approval Request

Evaluator Approval Request

Compliance Supervisor Request

Therapist Approval Request

Reports

Employer Notification Form

Group Attendance Report

Physician Prescription Report

Self-Report

Supervisor Report

Therapy Report (Initial)

Therapy Report (Quarterly)

 

Temporary Licenses issued under Executive Order 57

The documents below apply to temporary licenses issued under Executive Order 57.

Licensed Professional Counselor

Licensed Professional Counselor - Frequently Asked Questions related to Continuity of Care

Executive Order 51

Executive Order 57

Application for Licensure as a Licensed Professional Counselor by Endorsement

Licensed Marriage and Family Therapist

Licensed Marriage and Family Therapist - Frequently Asked Questions related to Continuity of Care

Executive Order 51

Executive Order 57

Application for Licensure as a Licensed Marriage and Family Therapist by Endorsement