1. (a) Each application shall include the following documents:

   1. (1) Application form,
   2. (2) Official transcript(s),
   3. (3) Internship/Practicum Documentation Form,
   4. (4) Completed criminal background check, and
   5. (5) Fees.

2. (b) The Application Form requires the following:

   1. (1) Identifying information;
   2. (2) Possession of other credentials;
   3. (3) Previous misconduct;
   4. (4) Education; and
   5. (5) Proposed professional practice.

3. (c) The Internship/Practicum Documentation form requires the following:

   1. (1) Identifying information; and
   2. (2) Time, place, location of practicum.

4. (d) The Supervision Agreement requires identifying information of supervisee and supervisor as follows:

   1. (1) Name of candidate;
   2. (2) Name of candidate's place of employment;
   3. (3) Location supervised experience hours are being accrued;
   4. (4) Candidate's contact information;
   5. (5) Signature of Candidate;
   6. (6) Name of Approved LPC Supervisor;
   7. (7) Name of Approved LPC Supervisor's place of employment;
   8. (8) LPC Approved Supervisor's contact information;
   9. (9) Signature of LPC Approved Supervisor;
   10. (10) Name of On-Site Supervisor;
   11. (11) On-Site Supervisor's licensure information;
   12. (12) Name of On-Site Supervisor's place of employment;
   13. (13) On-Site Supervisor's contact information;
   14. (14) Signature of On-Site Supervisor.

5. (e) The Verification of Academic Standing requires the following information:

   1. (1) Name of applicant;
   2. (2) Name of university;
   3. (3) Name of graduate program;
   4. (4) Name of degree;
   5. (5) Total number of graduate coursework hours required to receive diploma;
   6. (6) Date of graduation;
   7. (7) Signature and signature date of applicant;
   8. (8) Name of administrator and/or school official;
   9. (9) Title/position of administrator and/or school official;
   10. (10) Telephone number of administrator and/or school official;
   11. (11) Email address of administrator and/or school official;
   12. (12) Signature and signature date of administrator and/or school official.

Added at 32 Ok Reg 139, eff 4-23-14 (emergency)

Added at 32 Ok Reg 1547, eff 9-11-15

Amended at 36 Ok Reg 492, eff 7-25-19

Amended at 40 Ok Reg 848, eff 8-11-23

Amended at 41 Ok Reg, Number 21, effective 7-25-24