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FORMS
License Application and Renewal Forms
Mail application forms and application fee to the Board's office: 
Board of Counselors & Therapists
3218 Pringle Road SE, Suite 250
Salem, OR   97302-6312
 
All application forms, fees and background check information must be submitted to the Board before application is considered complete.
Application Forms

 2014 Renewal Forms 
 

 Continuing Education Waiver Forms

 Scroll down for other forms.

Which Application Forms Do I Need?
If you are going to register as an intern to gain hours toward licensure, submit the following to the Board:
  • Form 1 Application 
  • Form 2A  Degree Program Direct Client Contact Hours 
  • Form 5 Professional Disclosure Statement
  • Form 6A Graduate Degree information ** (completed by your college)
  • Form 7 Intern Supervised Clinical Experience Plan
  • Criminal background check/fingerprints (Fingerprint instructions)
  • Your college transcript mailed directly from your college to the Board Office
  • Application fee of $172.25
 
All forms and fees must be completed and submitted to the Board before you can begin accruing supervised hours toward licensure.
 
If you apply by the direct method, submit the following to the Board:
  • Form 1 Application
  • Form 2 Post-Degree Supervised Clinical Experience   >> See note below.
  • Form 2A Degree Program Direct Client Contact Hours 
  • Form 3 Exam verification (if appropriate)
  • Form 5 Professional Disclosure Statement
  • Your college transcript mailed directly from your college to the Board Office
  • Criminal background check/fingerprints (Fingerprint instructions)
  • Form 6A Graduate Degree information  **
  • Application fee of $172.25. 
 
If you apply for license using the reciprocity method, submit the following to the Board.
  • Form 1 Application
  • Form 4 Verification of License from another state
  • Form 5 Professional Disclosure Statement
  • Your college transcript mailed directly from your college to the Board Office
  • Criminal background check/fingerprints (Fingerprint instructions)
  • Form 6A Graduate Degree information  **
  • Application fee of $172.25
 
If you are unsure which forms to submit, please contact the Board office for guidance.
 
>> Clinical experience reported on Form 2 must have been earned in Oregon before 2002 or in another state.
 
** Form 6a is not needed if you graduated from a university or college that was accredited (at the time you graduated) by CACREP, CORE, or COAMFTE, or was one of 12 Oregon Board-approved programs.

Other Forms