Official SealDepartment of Budget and Management

Supplemental Questionnaire

Last Name
First Name

Do you possess a current license as a Certified Associate Counselor-Alcohol and Drug (CAC-AD) from the Maryland Board of Professional Counselors and Therapists?

Yes No

If you answered Yes to the previous question, please provide the license number and expiration date in the box below.  A copy of your current license or license verification should also accompany your application.

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