Department Forms
Application Packets:
Forms:
- Academic Worksheet (LPC)
- Academic Worksheet (LMFT)
- Academic Worksheet (LBP)
- Affidavit of Lawful Presence (LPC, LMFT, LBP, LGC)
- Application (LPC, LMFT, LBP)
- Application (LGC)
- Application Instructions (LPC, LMFT, LBP)
- Application Instructions (LPC, LMFT, LBP Endorsement)
- Application Instructions (LGC)
- Application Inventory (LPC, LMFT, LBP)
- Application Inventory (LPC, LMFT, LBP Endorsement)
- Application Inventory (LGC)
- Approved Supervision Equivalency Course Contacts (LPC, LMFT)
- Complaint Form (LPC, LMFT, LBP, LGC)
- Continuing Education Roster (LPC Licensees)
- Continuing Education Roster (LMFT Licensees)
- Continuing Education Roster (LBP Licensees)
- Continuing Education Roster (LGC Licensees)
- Continuing Education Roster (LPC Supervisors)
- Continuing Education Roster (LMFT Supervisors)
- Document of Recommendation (LPC, LMFT, LBP)
- Document of Recommendation (LGC)
- Documentation of Supervision (LGC)
- Duplicate Card/License Request (LPC, LMFT, LBP, LGC)
- Evaluation of Professional Setting (LPC, LMFT, LBP)
- Evaluation of Supervised Experience (LPC)
- Evaluation of Supervised Experience (LMFT)
- Evaluation of Supervised Experience (LBP)
- Evaluation of the Supervised Experience - Supervisee (LMFT Supervisee)
- Information Update Form (LPC, LMFT, LBP, LGC)
- Internship and Practicum Documentation (LPC, LMFT, LBP)
- License Request (LGC)
- On-Site Supervision Verification (LPC, LMFT)
- Out-of-State Verification (LPC, LMFT, LBP Endorsement)
- Reactivation Request (For Inactive licenses only)
- Record of Supervised Experience (LPC)
- Record of Supervised Experience (LMFT)
- Record of Supervised Experience (LBP)
- Statement of Professional Disclosure (LPC, LBP Candidates)
- Statement of Professional Disclosure (LPC, LBP Licensees)
- Supervision Agreement (LPC, LBP)
- Supervision Agreement (LMFT)
- Supervision Agreement (LGC)
- Supervisor Application (LPC)
- Supervisor Application (LMFT)
- Supervisor Application (LBP)
Professional Counselor Licensing Division
1000 N.E. 10th Street
Oklahoma City, OK 73117-1299
(405) 271-6030, FAX (405) 271-1918
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Q: How may forms be submitted to the PCL Division?
A: Forms may be submitted by mail to OSDH-PCL, 1000 N.E. 10th St., Oklahoma City, OK, 73177, fax to (405) 271-1918, or email to Carolynkm@health.ok.gov.
Q: If I submit a form electronically, do I need to submit an original by mail?
A: No, please do not submit an original form in addition to the form sent by electronic means.
Q: If I am submitting a fee with my paperwork, may I submit my form and payment electronically?
A: Not at this time. If you are submitting a fee, your payment should be submitted with the accompanying paperwork by mail to OSDH-PCL, P.O. Box 268823, Oklahoma City, OK, 73126. This will ensure a timelier processing of your request.
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