Licensure Paperwork Request Form

Dear Graduate: Congratulations on meeting this professional milestone! Your application for licensure, whether you are a new graduate and are applying for the first license of your professional career or you have completed your post graduate hours and are applying to take the exam and become fully licensed is an amazing accomplishment! Please complete the form below and upload the form(s) that need completion, as well as any supporting documents. Forms will typically be completed and mailed or emailed to you within three weeks, excluding holidays.  


 

Graduate Personal Information

 
 
 
 
 
Phone
 
 

Licensure Request

 
 
 

Program Information

 
 
 
 
 
 

Clinical Experience

 

Please include the internship site name and complete address.

 
 

Please include the internship site name and complete address.

 
 

Please include internship supervisor's full name, including their credentials.

 

Please include internship supervisor's full name, including their credentials.

 

Please include internship advisor's full name, including their credentials.

 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 

This applies to MFT/MFTNU Grads only.

 
 

Upload your completed licensure paperwork here in PDF form. Please be sure to complete your portion BEFORE you submit your form to the program for completion. Not uploading a completed form will result in your application denied.

Drop your files here
 

Please include any additional comments that could help us process your Licensure Submission.