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Application for Licensure Professional Counselor ...

Attach a clear, full-face passport- What are you applying for? style photograph (2 x 2 ) of your Authorization to sit for the head and shoulders, taken within National Counselor Exam the past six months. New Jersey Office of the Attorney General Licensure as an Associate A photo is required with each Division of Consumer Affairs Counselor State Board of Marriage and Family Therapy Examiners Application . Professional Counselor Examiners Committee Licensure as a Professional 124 Halsey Street, 6th Floor, Box 45044 Counselor Do not use staples to attach the Newark, New Jersey 07101. photo. (973) 504-6582 Licensure as a Rehabilitation Counselor Application for Licensure Professional Counselor /Rehabilitation Counselor /Associate Counselor Date :_____.

Application Categories I hereby apply for the following type of license: (Please check the appropriate boxes.) Licensed Professional Counselor (L.P.C.)

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