License Application

License Application
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Social Security Number*
Gender

MaleFemale
Race

Not providedWhiteBlackNativeAsianHispanicOther
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Education History
School Name
Major
Degree Awarded (if awarded):
Degree Conferred Date:

MonthDayYear

Latest or Current Professional or Clinical Experience
Date of Experience From:

MonthDayYear
Date of Experience To:

MonthDayYear
Place of Employment:
Hours Worked Per Week:
Supervisor Name:

Ministerial Experience
Date of Experience From:

MonthDayYear
Date of Experience To:

MonthDayYear
Name of The Church or Organization:
Church or Organization Address

Street Address

Street Address Line 2

CityState

Zip Code
Church or Organization Phone Number
Please enter a valid phone number.
Name of the Main Leader of the Church or Organization

First NameLast Name

Documents

The documents can also be sent via email to info@abocpc.com. The application will not be processed until compeltion of the file.
Identification (Drivers License, Passport, State Identification Card, or similar)

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CV or Resume

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Degrees or Certificates

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Transcripts

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Ministerial Credentials

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Ministerial Reference Letter

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Two (2) Personal or Professional Reference Letters

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Application Fee Payment
How would you like to pay the fees?*

Pay Online Now with Debit/Credit Card, Apple Pay or Google PayPay with Zelle or another method (you will need to manually submit your payment confirmation via email)
Receipt of Application Fee*

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Application Fees:

NEW License (Bachelor Degree or Higher)Licensed Christian Clinical CounselorLicensed Christian CounselorLicensed Christian Marriage and Families CounselorLicensed Christian Clinical PsychologyLicensed Christian Psychology

$125.00

NEW LicenseLicensed Pastoral Counselor Licensed Biblical Counselor

$125.00

License Renewal (Bachelor Degree or Higher)Licensed Christian Clinical CounselorLicensed Christian CounselorLicensed Christian Marriage and Families CounselorLicensed Christian Clinical PsychologyLicensed Christian Psychology

$100.00

License RenewalLicensed Pastoral Counselor Licensed Biblical Counselor

$100.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

I authorize American Board of Certified Professional Counselors to charge my credit card above for agreed-upon purchases. I understand that this payment is not refundable.
Applicant's Signature*

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License Application

Education History

Latest or Current Professional or Clinical Experience

Ministerial Experience

Physical and Mental Health Disorders Impacting Ability to Practice

Substance-Related Disorders Impacting Ability to Practice

Discipline and Criminal History

Documents

Application Fee Payment

Payment Methods