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Applications & Forms

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QMHP – Adult

Please review the QMHP Online 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 coursework outline form

QMHP – Child

Please review the QMHP Online 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 review the QMHP Online 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 review the QMHP Online 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 and RPRS Forms

(The forms below are to supplement the online application and do not include the instructions. All forms and instructions can 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 view/print the instructions and required supplemental documentation. All forms, with the exception of your official transcript, can be uploaded during the online application process. Once you pay the application fee, you will no longer have the ability to upload your required documentation. Forms and information not uploaded during the online process should be emailed or mailed to the Board. 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 or Qualified Mental Health Professional-Child

Reinstatement Application Following Revocation or Suspension for QMHP-A or QMHP-C Registration

Application for Reinstatement of a Registered Peer Recovery Specialist Registration

Application for Reinstatement Following Revocation or Suspension of a Registered Peer Recovery Specialist Registration

LPC Licensure Process Handbook

Online Application Handbook

Sample of a Resident in Counseling Supervisory Contract

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.

Application for Reinstatement of Resident in Counseling License

 

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

Reinstatement Application Packet for Licensed Professional Counselors (Not applicable for LPC temporary COVID licenses.)

Application Packet for Reinstatement of a Revoked or Suspended License

Additional LPC Forms

Verification of Coursework Form for LPC Licensure

Verification of Degree and Internship Form for LPC

Supervisor Out of State License or Certification Verification Form

Verification of Supervision Form for LPC Licensure

Quarterly Evaluation Form for LPC Licensure

Supervision Summary Form for LPC Licensure

Request for Termination of Supervision Form

Out of State License or Certification Verification Form

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

Request for Verification of VA License or Certification Form

Doctoral Verification of Internship/Practicum for LPC

Request for Inactive Status of Current Active License

 

Certified Substance Abuse Counselors

CSAC and CSAC-A Certification Process Handbook

CSAC Supervisee applications are now accepted through our online system. Click here to begin the CSAC Supervisee Initial or Add/Change Registration of Supervision License Application.

Sample of a CSAC Supervisee Supervisory Contract

CSAC applications are now accepted through our online system. Click here to begin the CSAC application by Examination or Endorsement.

Reinstatement

Reinstatement Application for Certified Substance Abuse Counselors

Reinstatement of Certificate Following Revocation or Suspension for Substance Abuse Counselor or Counseling Assistant  

 

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

CSAC-A applications are now accepted through our online system. Click here to begin the CSAC-A application by Examination.

Reinstatement

Reinstatement Application for Certified Substance Abuse Counselor Assistant

Reinstatement of Certificate Following Revocation or Suspension for Substance Abuse Counselor or Counseling Assistant  

 

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 

 

Online Application Handbook

Sample of a Resident in Substance Abuse Treatment Supervisory Contract

Temporary License 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.

Application for Reinstatement of Resident in Substance Abuse Treatment License

 

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

Reinstatement Application for Licensed Substance Abuse Treatment Practitioners

Application Packet for Reinstatement of a Revoked or Suspended License

Additional LSATP Forms

Quarterly Evaluation Form for LSATP Licensure

Supervision Summary Form for LSATP Licensure

Verification of Supervision Form for LSATP Licensure

Verification of Required Coursework for LSATP Licensure

Verification of Degree and Internship

Supervisor Out of State License or Certification Verification Form

Out of State License or Certification Verification Form

Request for Termination of Supervision Form

Request for Verification of VA License or Certification Form

Verification of Post-Licensure Active Practice Form

Request for Inactive Status of Current Active License

 

LMFT Licensure Process Handbook

Online Application Handbook

Sample of a Resident in Marriage and Family Therapy Supervisory Contract

Temporary License 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.

Application for Reinstatement of Resident in Marriage & Family Therapy License 

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

Reinstatement Application for Marriage and Family Therapist (Not applicable for LMFT temporary COVID licenses.)

Application Packet for Reinstatement of a Revoked or Suspended License

Additional LMFT Forms

Verification of Supervision Form for LMFT Licensure

Quarterly Evaluation Form for LMFT Licensure

Verification of Clinical Practice for 24 of the Last 60 Months for LMFT Licensure

Supervision Summary Form for LMFT Licensure

Verification of Coursework for LMFT Licensure

Verification of Internship form for LMFT Licensure

Supervisor Out of State License or Certification Verification Form

 

Out of State License or Certification Verification Form

Request for Termination of Supervision Form

Request for Verification of VA License or Certification Form

Doctoral Verification of Internship/Practicum for LMFT Licensure

Request for Inactive Status of Current Active License


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Virginia Board of Counseling
Email: Coun@dhp.virginia.gov
Jaime Hoyle, Executive Director
Gerard Lawson, Ph.D., LPC, LSATP, Chairperson