Get Application For Licensure As A Mental Health Counselor (lmhc) - In.gov - In

Filling out your application for licensure as a mental health counselor can be a straightforward process with the right guidance. This guide will provide you with clear, step-by-step instructions to complete the form accurately and efficiently.

Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to access the application form and open it for editing.
2. Begin by entering your personal information in the applicant information section. Include your name (last, first, middle), current address, permanent address (if different), work and home telephone numbers, social security number, date and place of birth, and email address.
3. Indicate whether you are applying for a temporary permit by selecting 'Yes' or 'No'. Also, specify how you wish your name to appear on your license.
4. Select your application type by checking the appropriate boxes: whether you are applying for licensure by examination, by exemption from examination (endorsement), or have been engaged in the practice of mental health counseling.
5. List your graduate education, including details such as the name and location of the academic institution, program title, degree earned, and dates attended.
6. Provide your employment history for the past five years. List all professional positions you've held, including details about your employers, job titles, dates of employment, supervisors, average hours worked per week, and responsibilities.
7. Complete the section regarding other state licensure or certification. Indicate any prior licenses or certifications held and their statuses.
8. If applicable, answer the questions regarding any disciplinary actions, denial of license applications, treatments for substance abuse, or any criminal convictions. Be prepared to provide detailed explanations if necessary.
9. Affirm the accuracy of your application by signing and dating the application affirmation section.
10. Authorize the release of information by completing and signing the authorization for release of information section.
11. Review the completed application thoroughly to ensure all information is accurate and complete before finalizing your submission.
12. Finally, save your changes, download or print the form. Make sure to retain a copy for your records.

Complete and submit your application for licensure online to begin your journey as a licensed mental health counselor.