Follow the steps to fill out and submit your form

1. Click ‘Get Form’ button to download the WA DOH 670-114 form and open it in your preferred editor for online completion.
2. Begin by entering the applicant's name and credential number in the designated fields. Ensure all entries are clear and legible.
3. Next, fill in the date of hire using the format MM/DD/YYYY. This field is crucial for confirming your employment status.
4. Select the type of Agency Affiliated Counselor by checking all applicable boxes: Employee, Juvenile Probation Counselor, or Student Intern.
5. Indicate if this is a new agency registration, an update or change in agency, or an additional agency by checking the appropriate box.
6. Complete the agency or facility employer name, physical address, city, state, and zip code in the respective fields.
7. Ensure that you confirm your agency status. The agency must be a county, state agency, federally recognized Indian tribe, or recognized by the Secretary of Health.
8. Finally, have the authorized employer or designated employee sign and date the form using the format MM/DD/YYYY.
9. Once all sections are completed, check for any errors or omissions, then save your changes. You can download, print, or share the finalized form as needed. Ensure that you send the completed form to the designated address.

Complete your WA DOH 670-114 online today to ensure your registration as an agency affiliated counselor.