Appendix 9998. FORMS (18VAC115-20)

Registration of Supervision - Post Graduate Degree Supervised Experience, LPC Form 1 (rev. 2/11).

Quarterly Evaluation, LPC Form 1-QE (rev. 2/11).

Licensure Verification of Out-of-State Supervisor, LPC Form 1-LV (rev. 2/11).

Licensure Application, LPC Form 2 (rev. 2/11).

Verification of Supervision – Post-Graduate Degree Supervised Experience, LPC Form 2-VS (rev. 2/11).

Coursework Outline Form, LPC Form 2-CO (rev. 2/11).

Verification of Internship Hours Towards the Residency, LPC Form 2-IR (rev. 2/11).

Verification of Internship, LPC Form 2-VI (rev. 2/11).

Verification of Licensure, LPC Form 2-VL (rev. 2/11).

Supervision Outline - Examination Applicants Only, LPC Form 2-SO (rev. 2/11).

Verification of Clinical Practice, 5 of Last 6 Years Immediately Preceding Submission of Application for Licensure, LPC Form-ECP (rev. 2/11).

Continuing Education Summary Form (LPC) (rev. 3/09).

Application for Reinstatement of a Lapsed License (rev. 8/07).

Application for Reinstatement of a Revoked, Suspended, or Surrendered License (rev. 8/07).