Ky Lpcc Online License PDF Details

The Kentucky Licensed Professional Clinical Counselor (LPCC) License form, a crucial document issued by the Kentucky Board of Licensed Professional Counselors, serves as the foundation for maintaining professional counseling credentials within the state. As delineated in the 2011 edition, this form is integral for the annual renewal process, adhering to the statutes outlined in KRS 335.535 and the specific regulations detailed in 201 KAR 36:020, which govern the profession. It stipulates a renewal fee of $150.00, payable to the Kentucky State Treasurer, and underscores the importance of adhering to the renewal deadline of October 31, 2011, to avoid licensure termination. The form also highlights the 60-day grace period, during which a late renewal incurs an additional fee, and mandates immediate cessation of practice for those who fail to renew by December 31, 2011. Additionally, it addresses requirements for those selected for audit, necessitating evidence of 10 hours of continuing education. Completing the form requires comprehensive personal and professional details, including any instances of felony convictions or disciplinary actions, thus ensuring that all licensed professional clinical counselors in Kentucky uphold the highest standards of integrity and professional development.

QuestionAnswer
Form NameKy Lpcc Online License
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslpcc license verification ky, ky lpcc renewal, lpca ky license renewal, kentucky lpcc license verification

Form Preview Example

2011 Edition

KENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS

PO BOX 1360

FRANKFORT KY 40602

http://lpc.ky.gov

RENEWAL APPLICATION FOR LICENSED PROFESSIONAL CLINICAL COUNSELOR

Your Licensed Professional Clinical Counselor credential expires on October 31, 2011. In accordance with KRS 335.535 and regulations (201 KAR 36:020) governing this profession, you are required to renew your license annually with the transmittal of this form and a renewal fee of $150.00, (check or money order) made payable to the Kentucky State Treasurer. Please return this completed form with the fee to the address above prior to the deadline date of October 31,2011. The fee for renewals received during the 60 day grace period is $25.00. Credentials not renewed prior to December 31,2011 will be terminated and you must immediately CEASE AND DESIST (no exceptions) the use of the title Licensed Professional Clinical Counselor in Kentucky.

If your renewal reminder indicated that you had been selected for AUDIT please send copies of evidence of having completed 10

hours of continuing education as defined in 201 KAR 36:030.

PLEASE COMPLETE ALL OF THE FOLLOWING:

Name

 

 

Present place of employment

 

Address

 

 

Address

 

 

Address

 

 

Address

 

 

City

State

Zip

City

State

Zip

Home telephone number

 

 

Business telephone #

 

Home e-mail address

 

 

Business e-mail address

 

_______________________________________________

License number

 

 

Social Security Number

 

 

 

 

 

(Please complete hack page ofrenewalform)

2011 Edition

1. Have you been convicted of a felony since your last application or renewal? “Conviction” including all instances in

which a plea of no contest is the basis of the conviction.

(

)No

(

 

)Yes

If yes, list offense and provide details on a separate sheet of paper.

 

 

 

 

 

2. Have you been subject to disciplinary action by a mental health credentialing board?

(

)No

 

(

) Yes

If yes, give details on a separate sheet of paper.

 

 

 

 

 

3.List any state in which you have become licensed or certified since your last renewal, the type of license or certification, and the number of the certification or license:

4. Are you currently serving in the military? (

) No

(

) Yes

5.If you are currently eligible to supervise LPCA’s please provide date of completion of required supervision training: Date of Board Approved Supervision Training

CERTIFICATE OF COMPLIANCE

I do certify under penalty of law that the information contained herein is true, correct, and complete to the best of my knowledge and belief. I am aware that, should investigation at any time disclose any such misrepresentation or falsification, my license could be subject to disciplinary action by the Kentucky Board of Licensed Professional Counselors

I have completed

hours of continuing education during the annual period for renewal as defined in 201 KAR 36:030.

If your renewal application indicates that you have been selected for AUDIT please send copies of evidence ofhaving completed 10

hours ofcontinuing education as defined in 201 KAR 36:030.

Signature:

Date:

/________ /________

 

(Sign your name - Do not print or type)

 

How to Edit Ky Lpcc Online License Online for Free

Due to the purpose of making it as quick to apply as it can be, we built the PDF editor. The entire process of filling out the kentucky plumbing license renewal application will be easy in the event you comply with the following steps.

Step 1: The first thing is to click the orange "Get Form Now" button.

Step 2: At this point, you can begin editing your kentucky plumbing license renewal application. Our multifunctional toolbar is readily available - insert, erase, change, highlight, and undertake other sorts of commands with the content in the form.

These segments will compose the PDF template that you will be filling out:

filling out ky board lpcc part 1

Fill out the Address, City, Address, State, Zip, City, State, Zip, Home telephone number, Business telephone, Home email address, Business email address, License number Social Security, and Please complete hack page of space using the data demanded by the application.

Filling out ky board lpcc stage 2

It is vital to put down particular information inside the area Have you been convicted of a, which a plea of no contest is the, Have you been subject to, If yes give details on a separate, Yes, List any state in which you have, certification and the number of, Are you currently serving in the, Yes, If you are currently eligible to, Date of Board Approved Supervision, CERTIFICATE OF COMPLIANCE, and I do certify under penalty of law.

stage 3 to filling out ky board lpcc

Explain the rights and responsibilities of the parties in the space I do certify under penalty of law, I have completed, hours of continuing education, If your renewal application, Signature, Sign your name Do not print or, and Date.

Entering details in ky board lpcc stage 4

Step 3: Click the button "Done". Your PDF form may be transferred. You will be able save it to your device or send it by email.

Step 4: Come up with around a couple of copies of your form to keep away from all of the forthcoming difficulties.

Please rate Ky Lpcc Online License

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .