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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 Work Experience (for LPC interns only)
  • Form 5 Professional Disclosure Statement
  • Form 6a Graduate program information ** (completed by your college)
  • Form 7 Intern Supervised Clinical Experience Plan
  • Criminal background check/fingerprints (contact the Board office)
  • Your college transcript mailed 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 Work Experience (for LPC only)
  • Form 3 Exam verification (if appropriate)
  • Form 5 Professional Disclosure Statement
  • Your college transcript mailed from your college to the Board Office
  • Criminal background check/fingerprints (contact the Board office)
  • Form 6a Graduate program 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 from your college to the Board Office
  • Criminal background check/fingerprints (contact the Board office)
  • Form 6a Graduate program 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 11 Oregon Board-approved programs.

Other Forms