Verification of Practicum and Internship Hours & Degree Awarded
Licensed Professional Counselors Board of Examiners (LPC Board) requires that Provisional Licensed Professional Counselor (PLPC) applicants must have a letter from their graduate program verifying the hours completed in their graduate practicum/internship. Please complete the form below.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Term and Year Practicum Course was Completed
*
Example: Spring 2019
Practicum Location
*
Practicum Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Practicum Supervisor's Name with Credentials
*
Practicum Supervisor's Email Address
example@example.com
Term and Year Internship Course was Completed
*
Example: Fall 2020
Internship Site Location
*
Internship Site Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Internship Supervisor's Name with Credentials
*
Internship Supervisor's Email Address
example@example.com
Graduation Date
*
Example: May 12, 2023
PLPC Supervisor's Name
First Name
Last Name
PLPC Supervisor's Email Address
example@example.com
If the verification letter is to be sent to another agency (other than the Louisiana State Board of Licensed Professional Counselors), please provide the name, address and email address of the agency.
Submit
Should be Empty: