- This page, Apply for a provisional genetic counselor license, is offered by
- Board of Registration of Genetic Counselors
- Bureau of Health Professions Licensure
- Department of Public Health
Apply for a provisional genetic counselor license
Contacts
Board of Registration of Genetic Counselors
Phone
The Details of Apply for a provisional genetic counselor license
What you need for Apply for a provisional genetic counselor license
- Social Security Number SSN
- Date and place of birth
- Mother's maiden name
- 2x2 passport style color photo with a white or off-white background. Copies and printer generated photos are not acceptable.
- A notary signature
- Official transcripts in a signed and sealed envelopes for all undergraduate programs/degrees, accredited (per ABGC or ABMMG) master’s or PhD genetic counselor programs/degrees, and any other post-secondary programs/degrees.
- Transcripts must be complete and state the degree and date conferred in mm/dd/yyyy format.
- Verification of licensure status, in signed, sealed envelopes, from any state or jurisdiction in which you now or have previously held any professional license. The state or other jurisdictions must send verifications directly to the Board.
- Submission of the Criminal Offender Record Information Request Form (CORI), found below
If applicable
- If you hold, or have ever held, any professional license, you must request and submit a National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank Self-Query. To request a Self-Query, please contact the National Practitioner Data Bank. Include the original report with this application. Make a copy for your records.
- Note: If you don't hold and have never held any professional licenses in any other state or jurisdiction, you don't need to submit a National Practitioner Data Bank self-query
- If you answer "yes" to any of the questions 14-19:
- Attach a separate sheet explaining the circumstances
Fees for Apply for a provisional genetic counselor license
All fees are non-refundable and non-transferable.
Note: When you apply for a full genetic counselor license, you will be required to pay an additional application and license fee for full licensure.
Name | Fee | Unit |
---|---|---|
Provisional Genetic Counselor License Application | $300 | each |
Handling charge for returned checks | $23 | each |
How to apply Apply for a provisional genetic counselor license
Go to the Health Professions Licensing Portal and create an account, or log into your existing account. If this is your first time using this new portal, please visit Health Professions Licensing System User Guide.
Next steps for Apply for a provisional genetic counselor license
Keep a copy
Keep a copy of the complete application and supporting documentation for your records. Employers may require that you provide them with a copy.
The Board is not able to provide copies of the application.
More info for Apply for a provisional genetic counselor license
The address printed on your license is a public record that is available to anyone who requests it. If you are using your home address, you may wish to consider changing this to an office address. You may request address changes online at the board’s website, or you may get a form online to submit to the Board’s office.