Lgpc Lcpc Form – Fill Out and Use This PDF

Larry Hogan, Governor ∙ Boyd K. Rutherford, Lt. Governor ∙ Robert R. Neall, Secretary

TRANSFER FROM LGPC to LCPC

APPLICATION INSTRUCTIONS

** IMPORTANT **

This form is to be used ONLY if you are a Maryland Licensed Graduate Professional Counselor (LGPC) with an active license, in good standing, and are seeking licensure as a Licensed Clinical Professional Counselor (LCPC).

BEFORE submitting your application, please:

□Retain a copy of all documents for your records. Documents will not be returned once received by the Board.

□All forms must be legible, complete, signed, and dated (where applicable) or processing may be delayed. If information and documentation was provided to the Board with your LGPC application, you do not need to provide it again. However, Maryland law requires that you obtain another criminal history record check (CHRC) even though you obtained one when you applied for LGPC. Forms for the CHRC are included with this application.

□Include a check or money order in the amount of $350 payable to:

Board of Professional Counselors and Therapists. Fees are non-refundable and non-transferable.

□Applications may not be submitted via fax or email. Please mail to:

Board of Professional Counselors and Therapists

Attn: Licensing Coordinator

4201 Patterson Avenue, Suite 316

Baltimore, MD 21215

ELIGIBLITY/REQUIREMENTS: The following is a summary only. For complete requirements and definitions, see Md. Code Ann. Health Occ., §17-101, et. seq. which may be found on the Board’s website,

www.health.maryland.gov/bopc.

□Education: Applicant shall:

Hold a master’s degree (minimum of 60 credits) or a doctoral degree (minimum of 90 credits) in a professional counseling or related field from an accredited educational institution approved by the Board.

Documentation of graduate coursework as set forth in COMAR 10.58.01.05A(2) and B, which includes 3 semester credits in each of the following areas:

▪Human growth and personality development;

▪Social and cultural foundations of counseling;

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▪Counseling theory;

▪Counseling techniques;

▪Group dynamics, processing, and counseling; ▪Lifestyle and career development; ▪Appraisal;

▪Research and evaluation;

▪Professional, legal, and ethical responsibilities; ▪Marriage and family therapy;

▪Supervised field experience; ▪Alcohol and drug counseling; ▪Diagnosis and psychopathology;

▪Psychotherapy and treatment of mental and emotional disorders.

□Clinical Supervision Requirements:

If you hold a master’s degree, as set forth above, you must have not less than three (3) years and

a minimum of 3000 hours of supervised clinical experience in professional counseling, of which two (2) years and 2,000 hours shall have been completed after the award of the master’s degree obtained under

the supervision of a Board approved supervisor. See COMAR 10.58.01.05B(2).

If you hold a doctoral degree, as set forth above, you must have not less than two (2) years and a minimum of 2000 hour of supervised clinical experience in professional counseling, one year of which shall have been completed after the award of the doctoral degree and obtained under the supervision of a Board approved supervisor. See COMAR 10.58.01.05B(3).

□Examinations. Applicant must pass the following:

1)The National Counselors Exam (NCE); and

2)Maryland Law Assessment.

1)NCE: Upon review of your application, the Board will determine if you are eligible to take the NCE. Once you are deemed eligible, the Board will send you written authorization and

instructions on how to register for the exam. The exam is computerized. Exam dates and locations can be found on the Board’s website. If you have already passed the NCE, please include a copy of your scores with the application.

2)Maryland Law Assessment

The purpose of the assessment is to determine if a candidate is familiar with the state laws and ethical code related to safe and effective practice across several content areas. The MLA is a no-fail, no score assessment. Content areas include supervision and ethics questions based on excerpts from the Code of Maryland Regulations (COMAR) and Md. Code Ann., Health Occupations Art., Title 17.

The MLA consists of 36 questions. You will be presented with readings and questions until all items are answered correctly. Upon successful completion, you will receive a Certificate of Completion that you will submit to the Board with your application for licensure or certification.

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Prior Board approval is not required to take the MLA. However, if you take the MLA before you submit an application for licensure/certification with the Board, please note the following:

-Should you later decide not to apply for licensure/certification with the Board, the MLA fee will not be refunded.

-You are responsible for submitting the MLA Certificate of Completion to the Board with your application for licensure/certification. Do not email, fax or mail the certificate of completion separately to the Maryland Board. MLA Certificates of Completion received without a completed application will not be retained.

-MLA Certificates of Completion are valid for one year from the date of the MLA. If you do not apply for licensure/certification within one year from the date of the MLA, you will be required to re-take the MLA at your additional expense.

To take the MLA, use the following link: www.academy.cce-global.org.

If you experience any issues, please contact the assessment administrator, CCE, Monday thru Friday 8:30am – 5pm at 336.482.2856. You may also email for technical support at support@cce-global.org. Please do not contact the Board regarding technical support issues.

If you have already taken and passed the previous Maryland Law Exam, this notice does not apply to you and no further action is necessary.

□Criminal History Records Check (instructions and form attached). All applicants must complete a criminal history records check (CHRC). Applicant must include a copy of the receipt from the CHRC with this application. This allows the Board to access the report online from the Criminal Justice Information System.

Please note: A license will not be issued unless and until the Board determines that the applicant has completed ALL requirements including required coursework, examinations, CHRC, and any other requirements set by the Board in accordance with Maryland law.

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Larry Hogan, Governor ∙ Boyd K. Rutherford, Lt. Governor ∙ Robert R. Neall, Secretary

TRANSFER FROM LGPC TO LCPC

APPLICATION

Please type or print all information.

I.VETERANS AND SPOUSAL PREFERENCE

Are you an active service member or the spouse of any active service member? □ Yes □ No

Are you a veteran or the spouse of a veteran who was discharged from active

duty under circumstances other than dishonorable within one year of filing this □ Yes □ No application?

II.DEMOGRAPHIC INFORMATION

Name: ________________________________________________________________________

Last	First	MI	Maiden
SSN: ____________________	Date of Birth: ______________ LGPC Lic.# ______________

Home Phone: ____________ Work: ____________ Cell: _____________ Email: ____________

Home Address: _________________________________________________________________

Street CityState Zip

Prior address: __________________________________________________________________

(If less than 3 years at current address) Street CityState Zip

Mailing Address: _______________________________________________________________

(If different than above)Street CityState Zip

Business: _____________________________________________________________________

NameStreet CityState Zip

Gender and Ethnicity: This information is optional and may be used for statistical purposes by authorized personnel.

Gender:	□ Male	□ Female
Ethnicity:	Are you of Hispanic or Latino origin?		□ Yes	□ No
	Check all that apply:
	□ American Indian or Alaska Native		□ Asian	□ White
	□ Black or African American		□ Native Hawaiian or Pacific Islander

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III. INFORMATION REGARDING BACKGROUND

Please answer Yes or No to each question.

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