Forms

Certification and Recertification Forms

Certification Forms

Employment Verification Form

Verification of Certification Form

Explanation of Direct Practice Experience Form

Request for Accommodations – Candidate Form

Request for Accommodations – Provider Form

Examination Information Brochure

Recertification Forms

Employment Verification Form

Consultation Verification Form

Activities Supporting Professional Associations (Volunteer) Verification Form

Chart Review Verification Form

Mentoring Information and Verification Form

Self-Assessment Verification Form

In-Service Log for Category B Credit

Recertification Information

Summary of Professional Development Activities Table

Comprehensive Listing of Professional Development Activities

Users Guide to Entering Professional Development Hours

Others

Disciplinary Complaint Reporting Form