Counseling Certificate Program Application

Counseling Certificate Program Application
Please have the available documents ready prior to completing your application:
- Current resume/CV (with education, experience, and licenses/certifications).
- Statement of intent (250-500 words) aligned to your chosen certificate(s).
- One (1) recommendation: advisor or supervisor attesting to academic/professional readiness.
- Official or unofficial transcripts (highest degree earned; current students include in-progress transcript).
- Proof of licensure/credential (if applicable).
- English proficiency evidence if required (international applicants).
Additional Items - Program-Specific (if requested)
- Play Therapy: prior coursework in child/adolescent counseling or equivalent experience.
- School Counseling: evidence of K-12 field experience (or plan to obtain).
- Marriage & Family: systems/family therapy fundamentals completed or planned.
- Rehabilitation: disability studies/rehab counseling foundations preferred.
You will be prompted to pay your $50 application fee prior to final submission.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Please upload your most current resume/CV (pdf, docx)

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Please upload your Statement of Intent (500 words max) aligned with your chosen certificate(s). Please include specific, meaningful professional experiences, as well as how this certificate aligns with your career goals. (pdf, docx)

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Please upload official or unofficial transcripts (highest degree earned; current students include in-progress transcript). (pdf, docx)

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Please upload proof of licensure/credential (if applicable). (pdf, docx)

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Please upload proof of English proficiency evidence if required (international applicants).

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Please select one of the following:

I am currently enrolled in a master's-level counseling programI have already completed a graduate counseling program

I certify that the information provided is true and complete. I understand this is a non-degree seeking certificate application. Completion of a certificate does not by itself grant licensure.
Eligibility for external credentialing is determined by the relevant board/organization*

YesNo
Please follow the link to pay your $50 application fee: https://commerce.cashnet.com/LSUHSCNOAH?CNAME=FEECOUNSEL.
Provide your confirmation number below.*
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