Get Cti Application. Texas Department Of State Health Services Professional Licensing And Certification

Filling out the Clinical Training Institution (CTI) permit application is an essential step for organizations seeking to provide chemical dependency counseling services. This guide offers clear insights and step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to successfully complete the CTI Application.

1. Click ‘Get Form’ button to access the application and open it to proceed with filling out the necessary fields.
2. Indicate whether you are submitting a new application or a renewal application by selecting the appropriate checkbox. If renewing, provide the previous permit number.
3. Fill in the organization information section, including the name of the organization, mailing address, city, state, ZIP code, telephone number, fax number, and facility license number.
4. State the exempt status of your organization and specify the number of qualified clinical counselors (QCCs) on staff.
5. Provide a detailed description of the services offered where interns will be placed, ensuring clarity and comprehensiveness in your explanation.
6. In the CTI Coordinator information section, print your name and specify your license type and number, along with your title.
7. Sign and date the application, affirming that all information provided is accurate and in compliance with department rules.
8. Attach the required documentation, including proof of registration with the Department and a signed ethical agreement, along with a written outline of reading assignments and training activities based on Knowledge, Skills, & Attitudes (KSA).
9. Once all sections are completed and attached documents are included, you can save changes, download, print, or share the form as needed.

Complete your CTI Application online to ensure your organization is prepared for certification.