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#19-000311-0006
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***
1.

In accordance with Health Occupations Title 17 and Code of Maryland Regulations 10.58.01.09, a candidate placed in this classification must be licensed as a Graduate Professional Counselor by the Board of Professional Counselors and Therapists.  Are you currently licensed as a Graduate Professional Counselor (LGPC)? 
Yes No

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