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Applications and Forms

  • 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 pdf format of 			Mental Health Counseling Licensure Application


  • Mental Health Counseling Exam Registration Form pdf format of 			Mental Health Counseling Exam Registration Form


  • Marriage and Family Therapists Licensure Application pdf format of 			Marriage and Family Therapists Licensure


  • Educational Psychologists Licensure Application pdf format of 			Educational Psychologists Licensure Application


  • Rehabilitation Counselors Licensure Application pdf format of 			Rehabilitation Counselors Licensure Application


  • 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 pdf format of 			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 pdf format of 			DPL Complaint Form



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