Get Wa Doh 670-114 2021

The WA DOH 670-114 form is essential for individuals seeking agency affiliated counselor credentialing. This guide will provide you with clear, step-by-step instructions on filling out the form online to ensure a smooth submission process.

Follow the steps to fill out the WA DOH 670-114 form accurately and efficiently.

1. Click ‘Get Form’ button to access the WA DOH 670-114 form and open it in your preferred environment.
2. Begin by indicating your type of agency affiliated counselor. Mark all applicable boxes: Employee, Juvenile Probation Counselor, or Student Intern.
3. Next, select one of the options provided: New Agency, Update/Change Agency, or Additional Agency, to clearly define your application status.
4. In the 'Agency Affiliated Applicant Name and Credential Number' section, please print the name of the applicant and write their credential number.
5. Provide the employer's name by filling in the 'Agency or Facility Employer Name' field accurately.
6. Input the 'Agency or Facility Physical Address' with the necessary details including street address, city, state, and zip code.
7. Confirm that the agency is recognized as eligible to employ agency affiliated counselors. Tick the appropriate box if the agency is a county agency, state agency, federally recognized Indian tribe within Washington State, or recognized by the Secretary of Health.
8. An authorized individual must print their name and sign the form in the 'Signature of employer or designated/authorized employee' field, followed by the date of signing in the specified format (MM/DD/YYYY).
9. Once all fields are correctly filled out, you may save your changes, download the completed form, or share it as required.

Complete your application by filling out the WA DOH 670-114 online today.