Virginia Board of Counseling
Applications and Instructions
Please contact the Board at (804) 367-4610 or coun@dhp.virginia.gov for information on the following forms:
Licensed Substance Abuse Treatment Practitioners Applications
Certified Substance Abuse Counseling Assistants Applications
The below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000 to view and print DHP's documents.
Certified Substance Abuse Counselors
Application packet for Certified Substance Abuse Counselors
Licensed Professional Counselor Application
Application package for Licensed Professional Counselors
Certified Rehabilitation Provider Application
General Application Information
Verification of Experience (Form 2)
Verification of Licensure/Certification (Form 3)
Verification of Out-of-State Supervisor (Form 4)
Application for Reinstatement of a Lapsed Certificate
Marriage and Family Therapist Applications
License Verification of Applicant (Form 2)
Verification of Supervision (Form 3)
Quarterly Evaluation (Form 3B)
License Verification for Out-of-State Supervisor (Form 4)
Verification of Internship (Form 6)
Verification of Internship Hours toward the Residency (Form 7)
Supervision Outline Form for Endorsement Applicants (Form 8)
Registration of Supervision Forms
Registration of Supervision Instructions
Registration of Supervision Form (Form A)
License Verification for Out-of-State Supervisor (Form B)
Quarterly Evaluation Form (3B)
Continuing Education Forms
Continuing Education Summary Form - LPC
Continuing Education Summary Form - LMFT