Mississippi State Board of Examiners for Licensed Professional Counselors

State of Mississippi seal


Today is:

 

Post-Graduate Supervisory Agreement Form
           (use this to begin supervision with LPC-S)
 
     Online
     OnlineThe online process creates your profile and uses electronic
              signatures to complete the agreement.
Instructions

 

    Application for LPC  
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  • Online  Instructions
  • Online Before you start the online application you should print and review the paper application to ensure that you have available all the documentation that is required. The application has 6 parts. Each part must be completed before you can move on to the next part. Once you have completed Part I, your profile is created and you can then login to your profile and complete the other parts at your leisure.
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  • Reference Application
  • PaperOnline application is required. Paper version is for reference only. Any paper applications received after June 20, 2015, will not be accepted.
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  • Supervision Reporting Form

  • Online
  • OnlineLPC-S and/or Supervisees may login to profile and prepare the Supervision Reporting Form online. Instructions
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    • Paper
    • PaperThis is a sample of the online Reporting Log. Supervisors may utilize their own forms to facilitate the tracking process with supervisees.  It is, however, preferred by the Board that you utilize the online Reporting Log found within your online profile on the App Info tab.

  • Application for Board Qualified Supervisor (BQS)

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    • PaperPaper   (For reference only - any paper applications received will be returned)
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  • PaperPaper
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  • Verification of Licensure in Other Jurisdiction -  See FAQ #2
  • 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.
  • Mississippi does not have a reciprocal agreement with other states; therefore you must meet all MS requirements. You must also complete the MS application and submit along with the application ALL supporting documents. (i.e. supervision verification forms, transcripts, scores, etc.)
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  • Verification of MS Professional Counselor License
  • -Third Parties - This form is to be used by third parties requesting Verification of MS License. (You must save the file to your desktop with the name of LPC in the filename and when sending request via email.) Faxed requests are not acceptable.
  • -MS LPC - If you  are a MS LPC or have been in the past, you may request verification of your MS Professional Counselor License through the Online Payment tab in your profile.  There is a $25 fee for the verification to be sent to another state licensing Board.
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  • Request for Mailing Labels
  • The MS LPC Board will no longer offer mailing lists for purchase.
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  • Address Change Form (Can now be made in your profile. - Login)
  • Use this form to change address, phone, or email.
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  • Name Change Request
  • Use this form to request name change on license.
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  • Replacement Wall Certificate Request
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