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#19-001562-0006
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.

Do you possess a Bachelor's degree in a health or human services counseling field from an accredited educational institution approved by the Board of Professional Counselors and Therapists OR completion of a program of studies judged by the Board to be substantially equivalent in subject matter and training?

If "yes", please indicate the name of the school where degree was earned, degree type (Master's, Doctoral, etc.), field of study, and the date the degree was earned in the space below. If no, please indicate N/A in the text box.


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