LICENSURE REQUIREMENTS FOR PROFESSIONAL COUNSELOR

• Item #8 E-mail Address- Provide an e-mail address that you check regularly. We will notify you via e-mail when
your application form is received. If there are any issues or questions concerning your application, these will be
communicated to you through e-mail.
• Item #9 Registrations- Provide complete information regarding any licenses or certifications you now hold or have
ever held in any profession.
• Item #10 Education- Make sure that you have reviewed the education criteria for licensure in Professional
Counseling. You may be required to provide an official transcript and a transcript evaluation in support of your
application.
• Item #11 Reference- Provide the requested information for the 3 persons who will be submitting a Professional
Reference form on your behalf. These forms must be provided directly to the Board from the reference. The Board
cannot accept these references from you or through your hands in any way.
• Item #12 Professional Credentials- Provide information regarding your professional certifications such as NBCC,
ACA, etc. This information may be valuable to the Committee particularly for reciprocal applicants.
• Item #13 Work History- Start with your most recent employment/experience and work backward in time. Account
for all gaps in time such as periods of unemployment or education.
• Items #14-23- Provide a written explanation for each of your “Yes” answers. Make sure that your name appears on
additional documents. Include documentation such as certified copies of court records, state disciplinary action
documents, letters of sanction from professional associations, etc.
• Read the Warning, Agreement and Affidavit. Remember, you are stating that you have read, and agree to abide
by, the rules and regulations. The rules are available on the Board’s web page at
http://plboards.state.wy.us/mentalhealth. Read them. Sign and date the application. Please sign in blue ink. Mail
the original application, appropriate fee and proof of legal presence to the Board.
Documentation of Legal Presence in the U.S.
• U.S. Code Title 8, Chapter 14, Section 1621 requires that all licensing agencies collect proof of legal presence in
the United States. Generally applicants find it easiest to provide a copy of a state issued birth certificate, a copy of
a passport, or a copy of a social security card.
• Originals will not be returned.
• If you cannot provide any of these documents, please refer to the enclosed List A and B for other acceptable
documents.
State License/Certification Verification
• Verification is required if you hold a license as a professional counselor for independent clinical practice, in good
standing, issued by a state regulatory board with legislatively granted authority to regulate the practice of
professional counseling.
• Complete only the Applicant section of the form and send it to the state licensing board(s) listed under item #9 on
your application. We recommend that you contact the licensing board before sending them the form. Most
licensing boards charge a fee to verify licenses.
• Do not complete this form yourself or send this form to the Committee with your application. It must be sent directly
to the Committee from the state licensing board where you hold a qualifying license.
Professional Reference
• You must request Professional References three (3) professionals with at least six (6) months of direct knowledge
of your abilities and professional performance in professional counseling.
• Professional References must be submitted on the forms provided by the Board. The reference may e-mail the
form to WyoMHPLB@wyo.gov, fax it to (307) 777-3508, or mail it to the address provided in these instructions.
• Professional References must be sent directly to the Committee from the reference and not forwarded through you.
• Professional References must have been written within six (6) months of your application date.
• Professional References will not be accepted from natural or legal relatives.