Please read all instructions and review the statutes and regulations, before beginning to complete the application. The statutes and regulations can be found our website, www.ksbsrb.ks.gov.
1. Application: Please answer all questions on the application completely and accurately. If there have been any convictions of a felony or other past or current events that potentially raise questions about your ability to merit the public trust, additional information will be requested.
2. Fee: $50.00 application fee paid online upon submission. FEES ARE NONREFUNDABLE.
3. Academic Background form: You must complete the Academic Background form and submit with your complete application.
4. Practicum Review form: You must complete the Practicum Review form and submit with your complete application. This form must be completed by the program director of your program. The completed form should be returned to you in a sealed envelope with their signature across the seal.
5. Transcript: An official transcript must be sent directly from the Registrar’s office to the Board office. Only transcripts received directly from the university can be accepted.
6. Student Applicant: If you have not received your degree, but are within four months of graduation, you are required to submit the Verification of Academic Requirements form. This form attests to the expected completion of academic requirements leading to conferral of the baccalaureate degree. The program director should return the completed form to you in a sealed envelope with their signature across the seal. Once your degree is conferred, an official transcript must be submitted to the Board office as outlined in the above paragraph.
7. Professional References: Three references are required as part of your complete application packet. The professional reference form included in the application packet will need to be copied.
a) Each reference should return the completed form to you in a sealed envelope with their signature across the seal. The three reference forms will need to be included when the application is submitted to the Board office. NOTE: It is very important that references sign across the seal of the envelope to assure the Board of the confidentiality and integrity of the referencing process. (see example on second page of instructions)
b) One of the references must be from the on-site supervisor from your current or most recently completed addiction counseling practicum. If this person is unavailable the director of the field education program or a designated person who has knowledge of your practicum based on your program records shall complete the form.
c) The additional two references must be authorized by law to practice addiction counseling or to practice in a related field.
8. Out-of-State Verification: If you are, or have ever been, licensed, registered, or certified in one of the behavioral or health sciences in another state, the Out-of-State Verification Form will need to be completed by the other state(s). This form needs to be returned directly to the Board office. Only forms received directly from the other state(s) can be accepted.
9. Review: It is extremely important for you to understand that the Board cannot determine whether you are eligible to sit for the examination until all the application materials have been received and approved by the Board office.
Please allow 30 days for review of your complete application. Please check the status of your application on the ACA portal.
When you submit your application to the Board office the following items should be included:
- The application form;
- The application fee of $50.00;
- Academic Background form;
- Practicum Review form in its signed sealed envelope;
- Verification of Academic Requirements form, if you are currently a student within four months of graduation;
- Three (3) completed Professional Reference Forms in their signed sealed envelopes.
Please submit a complete application so that your application will not have to be returned.
These additional items need to be sent directly to the Board office by the appropriate institutions:
- Upon graduation, or if you have already graduated, you must request an official transcript that shows the degree earned and the date the degree was conferred from your university;
- An Out-of-State Verification Form, if ever licensed in another state
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