Forms

Mississippi State Board of Examiners for Licensed Professional Counselors

State of Mississippi seal

Today is: Wednesday, June 19, 2013

Forms

Fee Schedule
LPC Application Instructions
Application for LPC
Course Verification Form
Background Check Authorization
Supervision Agreement Form
Supervision Reporting Form
Application for Board Qualified Supervisor (BQS)
Complaint Form
Verification of Licensure in Other Jurisdiction
If you are applying for licensure in MS and currently hold a license in another state, submit this form to the state where you hold a license to practice Professional Counseling.
Verification of MS Professional Counselor License
Request for Verification of License
Request for Mailing Labels
If you would like to request mailing labels of MS LPCs, please use this form to submit your request.
Change of Information Form
Use this form to change name, address, phone,or email.
CE Hours Reporting Form
2013 LPC Renewal Form