Applications and Forms

Main Menu

Breadcrumbs

Important Notice Regarding Licensure Applications

As of January 1, 2010 all licensure applications must include two professional references on forms furnished by the Board for such purpose. All applications will be updated to include the required form and instructions in the coming months.
Mental Health Counseling Licensure Application
Mental Health Counseling Exam Registration Form
Marriage and Family Therapists Licensure Application
Educational Psychologists Licensure Application
Rehabilitation Counselors Licensure Application
Wall Certificate Request Form
Online Address Change for Allied Mental Health and Human Services Professionals

The Online Change of Address feature allows you to change your address of record listed in our database. To use this function, you must provide certain information for authorization.
Change of Name or Request for Duplicate License for Board of Registration of Allied Mental Health and Human Services Professionals

This PDF form maybe used to request a name change, address change or a duplicate license.
Health Care Fraud Complaint Application

Note: The Health Care Fraud Application is for use by insurance companies and fraud agencies.
Division of Professional Licensure Complaint Form

Main Menu