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Virginia Board of Counseling
Applications and Instructions

 

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Certified Substance Abuse Counselors

The Virginia Board of Counseling recently updated the application packets for CSACs (registration of supervision, by examination, and by endorsement). Old versions of the application will be accepted until July 1, 2016.

Application Packet for CSAC Supervision (Initial and Add/Change) (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 (Word .doc)

Substance Abuse Counselor or Counseling Assistant Application for Reinstatement of Certificate Following Revocation or Suspension (Word .doc)

 

Certified Substance Abuse Counselor Assistants

Application packet for Certified Substance Abuse Counselor Assistant (Word .doc)

Reinstatement Application for Certified Substance Abuse Counselor Assistant (Word .doc)

Substance Abuse Counselor or Counseling Assistant Application for Reinstatement of Certificate Following Revocation or Suspension (Word .doc)

 

Licensed Professional Counselors

LPC Licensure Process Handbook (PDF file)

Application Packet for Initial Supervised Residency (Word .doc)

Application Packet to Add/Change to Supervision (Word .doc)

Application Packet for LPC by Examination (Word .doc)

Application Packet for LPC by Endorsement (Word .doc)

Reinstatement Application Packet for Licensed Professional Counselors (Word .doc)

Application Packet for Reinstatement of a Revoked, Suspended or Surrendered License (Word .doc)


Additional LPC Forms

Verification of Education and Internship Form (Word .doc)

Licensure Verification of Out of State Supervisor (Word .doc)

Verification of Clinical Supervision (Word .doc)

Quarterly Evaluation (Word .doc)

Request for Termination of Supervision (Word .doc)

Verification of LPC License from Another State (LPC Endorsement Applicants) (Word .doc)

Verification of Clinical Practice for 24 of the Last 60 Months (Word .doc)

Request for Name and/or Address Change (Word .doc)

Request for Verification of Virginia LPC License (Word .doc)

 

Supervisor Approval Application for LPC and LMFT

Application For Board Approved Professional Counselor Supervisor

 

Licensed Substance Abuse Treatment Practitioners

Registration/Application Packet for Licensed Substance Abuse Treatment Practitioners (Word .doc)

Reinstatement Application for Licensed Substance Abuse Treatement Practitioners (Word .doc)

 

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 (Word .doc)

Verification of Experience for Rehabilitation Provider Certification (Word .doc)

Verification of Licensure/Certification (Word .doc)

Licensure/Certification Verification of Out-of-State Supervisor (Word .doc)

Rehabilitation Provider Application for Reinstatement of a Lapsed Certificate (Word .doc)

 

Marriage and Family Therapists

LMFT Licensure Process Handbook (PDF file)

LMFT Application Packet for Initial Supervised Residency (Word .doc)

LMFT Application Packet to Add/Change to Supervision (Word .doc)

Application Packet for LMFT by Examination (Word .doc)

Application Packet for LMFT by Endorsement (Word .doc)

Reinstatement Application for Marriage and Family Therapist (Word .doc)

 

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 (Word .doc)

Self Report Form

Licensed Professional Counselor (Word .doc)

Performance Evaluation Form

Supervisor Report Form – Behavioral Sciences (Word .doc)

Chaperone Report Form (Word .doc)

Miscellaneous Forms

Chaperone Fact Sheet (Word .doc)

Drug Log for Prescribers (.xls)

Employer Notified of Board Order (Word .doc)

Initial Contact Form (Word .doc)

Prescriber Report to Board of Drugs or Prescription Given to Licensee (Word .doc)

Recovery Support Group Attendance Log (Word .doc)

Approval Forms

Chaperone Approval Request Form (Word .doc)

Evaluator Approval Request (Word .doc)

Supervisor Approval Request – Behavioral Sciences (Word .doc)

Therapist Approval Request (Word .doc)