Skip to content
Main Menu
Search Menu
About Us
About Us
Overview
Services By Region
Our Mission & Vision
Our Ministry of Service
Diversity, Equity and Inclusion
Financial Accountability
Board of Directors
Our Leadership
Donate
Careers
News & Publications
News & Publications
Overview
In the News
News Releases
Your Impact Stories
Our Latest Publications
VOACC Blog
Get Involved
Get Involved
Overview
Adopt A Family
Volunteer Opportunities
Corporate Year of Service
Operation Backpack®
Harvest for Hope
G.O.A.T. Expo
Volunteer
Donate
Search
Volunteer
Donate
Volunteer
Donate
Donate now
Professional Licensure/Certification
1. First name
*
2. Last name
*
3. Type of professional license:
*
LCPC (Licensed Clinical Professional Counselor)
LGPC (Licensed Graduate Professional Counselor)
LCSW (Licensed Clinical Social Worker)
LGSW (Licensed Graduate Social Worker)
LPC (Licensed Professional Counselor)
RN (Registered Nurse)
LPN (Licensed Professional Nurse)
MA (Medical Assistant)
CNA (Certified Nursing Assistant)
RPS (Registered Peer Supervisor)
CPRSS (Certified Peer Recovery Support Specialist)
Other:
If other:
4. Professional license renewal date:
5. State where you have your professional license:
6. What is the relevant credential in which you can provide professional supervision to count towards licensure/certification for a supervisee (i.e.; LCPC Board Approved Supervisor) or N/A?
7. What Board or Professional Entity issues your professional license?
8. What is the fee to renew your professional license?
9. Will you have what you need (training, funding, etc.) to renew your professional license in time?
10. Are you currently pursuing a professional license that you do not already have?
11. If so, what type of professional license are you pursuing?
12. What is the expected date of attainment of the above professional license you are pursuing?
13. Is the professional license required for your position with VOAC?
Return to top of page