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When seeking to maintain your Licensed Professional Clinical Counselor (LPCC) credential in Kentucky, timely completion of the renewal application form is crucial. This form serves as your official request to renew your license and consists of essential information you must provide, including your name, contact details, and license number. It's important to be aware that your license will expire annually on October 31. To avoid interruptions in your practice, you must submit this form along with a renewal fee of $150 before the deadline. Renewals can still take place during a 60-day grace period, but expect a reduced fee of $25 during this timeframe. Be particularly attentive to any audit notifications that require you to substantiate your completed continuing education hours, as this is vital for sustaining your practice in compliance with state regulations. The form also prompts you to disclose any changes to your legal status or disciplinary actions, ensuring that the Board remains informed about your professional history. Failure to renew your license before the end of the grace period on December 31 will result in termination, necessitating an immediate halt to your practice as an LPCC in Kentucky. Your compliance with these requirements is not only a matter of legality but also one of professional integrity.

Ky Lpcc License Example

2011 Edition

KENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS

PO BOX 1360

FRANKFORT KY 40602

http://lpc.ky.gov

RENEWAL APPLICATION FOR LICENSED PROFESSIONAL CLINICAL COUNSELOR

Your Licensed Professional Clinical Counselor credential expires on October 31, 2011. In accordance with KRS 335.535 and regulations (201 KAR 36:020) governing this profession, you are required to renew your license annually with the transmittal of this form and a renewal fee of $150.00, (check or money order) made payable to the Kentucky State Treasurer. Please return this completed form with the fee to the address above prior to the deadline date of October 31,2011. The fee for renewals received during the 60 day grace period is $25.00. Credentials not renewed prior to December 31,2011 will be terminated and you must immediately CEASE AND DESIST (no exceptions) the use of the title Licensed Professional Clinical Counselor in Kentucky.

If your renewal reminder indicated that you had been selected for AUDIT please send copies of evidence of having completed 10

hours of continuing education as defined in 201 KAR 36:030.

PLEASE COMPLETE ALL OF THE FOLLOWING:

Name

 

 

Present place of employment

 

Address

 

 

Address

 

 

Address

 

 

Address

 

 

City

State

Zip

City

State

Zip

Home telephone number

 

 

Business telephone #

 

Home e-mail address

 

 

Business e-mail address

 

_______________________________________________

License number

 

 

Social Security Number

 

 

 

 

 

(Please complete hack page ofrenewalform)

2011 Edition

1. Have you been convicted of a felony since your last application or renewal? “Conviction” including all instances in

which a plea of no contest is the basis of the conviction.

(

)No

(

 

)Yes

If yes, list offense and provide details on a separate sheet of paper.

 

 

 

 

 

2. Have you been subject to disciplinary action by a mental health credentialing board?

(

)No

 

(

) Yes

If yes, give details on a separate sheet of paper.

 

 

 

 

 

3.List any state in which you have become licensed or certified since your last renewal, the type of license or certification, and the number of the certification or license:

4. Are you currently serving in the military? (

) No

(

) Yes

5.If you are currently eligible to supervise LPCA’s please provide date of completion of required supervision training: Date of Board Approved Supervision Training

CERTIFICATE OF COMPLIANCE

I do certify under penalty of law that the information contained herein is true, correct, and complete to the best of my knowledge and belief. I am aware that, should investigation at any time disclose any such misrepresentation or falsification, my license could be subject to disciplinary action by the Kentucky Board of Licensed Professional Counselors

I have completed

hours of continuing education during the annual period for renewal as defined in 201 KAR 36:030.

If your renewal application indicates that you have been selected for AUDIT please send copies of evidence ofhaving completed 10

hours ofcontinuing education as defined in 201 KAR 36:030.

Signature:

Date:

/________ /________

 

(Sign your name - Do not print or type)

 

File Breakdown

Fact Name Description
Renewal Requirement The renewal application for the Licensed Professional Clinical Counselor must be submitted annually. The application is accompanied by a renewal fee of $150.00, payable to the Kentucky State Treasurer.
Grace Period Fee If the renewal application is submitted during the 60-day grace period following the October 31 deadline, a reduced fee of $25.00 is required.
Termination of License Failure to renew the license by December 31, 2011, results in the immediate termination of the credential. You must cease the use of the title "Licensed Professional Clinical Counselor" in Kentucky.
Governing Laws This license renewal is governed by Kentucky Revised Statutes (KRS) 335.535 and administrative regulations (201 KAR 36:020).

Guide to Using Ky Lpcc License

Filling out the Kentucky LPCC License form is an important step in maintaining your professional standing. It requires careful attention to detail, along with specific information about your employment and credentials. To ensure the process goes smoothly, follow the outlined steps below.

  1. Obtain the Form: Download or print the renewal application form from the Kentucky Board of Licensed Professional Counselors website.
  2. Complete Your Personal Information: Fill in your name, present place of employment, and full address. Make sure to include your city, state, and zip code.
  3. Provide Contact Information: Enter your home telephone number, business telephone number, and both personal and business email addresses.
  4. Fill in License Details: Write your license number and your Social Security number on the designated lines.
  5. Answer Questions: Respond to the five questions regarding convictions, disciplinary actions, additional licenses, military service, and supervision training. Indicate "Yes" or "No" as needed, and provide details on a separate sheet for any affirmative responses.
  6. Certify Your Information: Read the statement of compliance carefully. By signing, you are confirming that all information is true and complete to the best of your knowledge.
  7. Sign and Date the Form: Sign your name in the designated area and enter the date.
  8. Prepare Payment: Include a check or money order for the renewal fee of $150, made payable to the Kentucky State Treasurer.
  9. Submit Your Application: Mail the completed form along with the payment to the address provided at the top of the form before the deadline.

Get Answers on Ky Lpcc License

1. What is the deadline for renewing my Ky LPCC License?

The deadline for renewing your Licensed Professional Clinical Counselor (LPCC) license is October 31 of each year. It is critical to submit your renewal application along with the required fee before this date to avoid any penalties.

2. What is the renewal fee for the Ky LPCC License?

The renewal fee for your Ky LPCC License is $150. This payment must be made via check or money order, payable to the Kentucky State Treasurer. If you miss the standard renewal deadline, you can still renew during a 60-day grace period for a reduced fee of $25.

3. What happens if I do not renew my license by December 31?

If your license is not renewed by December 31, it will be terminated. You must immediately cease the use of the title Licensed Professional Clinical Counselor in Kentucky. No exceptions will be made regarding this rule.

4. What should I do if my renewal reminder indicates I am selected for an audit?

If you are selected for an audit, you are required to provide evidence of having completed 10 hours of continuing education during the renewal period. Make sure to submit copies of your continuing education documentation along with your renewal form.

5. Is there any specific information I need to provide on the renewal form?

You will need to provide the following information on the renewal form:

  • Your name
  • Current place of employment
  • Your home and business contact details
  • Your license number
  • Your Social Security Number

Additionally, you must answer questions about any felony convictions or disciplinary actions, if applicable.

6. Can I still apply for renewal if I am currently serving in the military?

Yes, if you are serving in the military, you can still apply for renewal. Make sure to indicate your military status on the renewal form.

7. Are there any continuing education requirements for renewal?

Yes, you must complete a minimum of 10 hours of continuing education as defined in 201 KAR 36:030. This is necessary for maintaining your licensure and must be documented if you are selected for an audit.

8. What happens if I provide false information on my renewal application?

Providing false information on your renewal application can lead to disciplinary action by the Kentucky Board of Licensed Professional Counselors. It is mandatory to certify that all information submitted is true, correct, and complete to the best of your knowledge.

Common mistakes

When filling out the Ky Lpcc License form, it is important to ensure that all information is accurate and complete. One common mistake people make is failing to include required fees. The application specifically states that a renewal fee of $150 is necessary for processing. Applicants sometimes neglect to submit this payment, which leads to delays or rejection of their application.

Another frequent error involves incomplete or incorrect personal information. The form requires basic details such as name, current employment, and contact information. When individuals overlook any section or provide incorrect information, it can create confusion and prevent the renewal from being processed efficiently. Double-checking this information for accuracy can save applicants considerable time.

Additionally, applicants often neglect to indicate any changes in licensing status. The form asks whether the person has received any licenses or certifications in other states since the last renewal. Failing to disclose this information may result in disciplinary action. Providing complete information maintains compliance with state regulations and reflects a commitment to transparency.

Lastly, many individuals make the mistake of not adhering to the documentation requirements for audits. If selected for an audit, it is crucial to submit copies of evidence proving completion of the necessary continuing education hours. Not providing this documentation, even if the renewal application is otherwise accurate, can lead to complications and potential license termination. Keeping thorough records of continuing education can simplify this process.

Documents used along the form

The process of obtaining and maintaining a Licensed Professional Clinical Counselor (LPCC) license in Kentucky often involves various complementary documents and forms. Each of these forms serves a specific purpose, contributing to the overall compliance and proper documentation required by the Kentucky Board of Licensed Professional Counselors. Below is a list of important documents frequently associated with the KY LPCC license application and renewal process.

  • Application for Licensure: This initial document is submitted when seeking to become licensed as a professional counselor. It contains personal details, education background, supervised experience, and other necessary credentials.
  • Continuing Education Documentation: Counselors must provide proof of completed continuing education hours during each renewal cycle. Documentation typically includes certificates from approved courses or training programs.
  • Verification of Supervised Experience: This form confirms the completion of required supervised clinical hours. It usually includes signatures from supervisors who verify the applicant's experience and competency in the field.
  • Background Check Authorization Form: To ensure safety and compliance, applicants must submit a request for a criminal background check. This form provides the necessary consent for the review of any felony convictions related to the applicant.
  • Military Status Verification: If applicable, this brief form confirms whether the applicant is currently serving in the military, which may influence licensing rules and deadlines for active members and veterans.
  • Disciplinary History Form: This form asks applicants to disclose any past disciplinary actions by mental health boards. Honest disclosure is vital, as nondisclosure can lead to serious penalties.
  • Renewal Fee Payment Authorization: Accompanying the renewal application, this procedure includes a method for ensuring the payment of relevant fees, which are required every renewal cycle.
  • Request for License Restoration: If a license has expired or been inactive, this application is necessary for restoring the license to good standing, including any stipulated requirements that must be met first.
  • Change of Address Form: If a licensed counselor changes their address, they must notify the Board of the new address to ensure that all records are accurate and up to date.
  • Ethics Complaint Form: In the event of a dispute or unethical behavior, this form allows individuals to file complaints formally with the Board for investigation and review.

Each of these documents plays a key role in supporting the professional practice of licensed counselors in Kentucky. By ensuring that all forms are completed accurately and submitted on time, counselors can maintain their licensure and continue to serve the community effectively.

Similar forms

  • Missouri LPC License Application: Similar to the Ky LPCC License form, this application also requires renewal on an annual basis, necessitating the submission of a renewal fee and possibly continuing education evidence.
  • California LPC Application: The California version mandates disclosure of any felony convictions and disciplinary actions, akin to the questions presented in the Kentucky form.
  • Texas LPC License Renewal: Texas requires LPCs to renew their licenses periodically, with details about continuing education and employment information mirroring those found in the Ky LPCC License form.
  • Georgia LPC License Renewal Application: This application also includes sections on criminal history and past disciplinary actions, paralleling the content and intent of the Kentucky form.
  • Illinois LPC License Application: Similarities arise in terms of renewal requirements and the necessity to report any changes in personal or professional status since the last application.
  • Florida LPC Renewal Application: The Florida application requires similar biographical details and criminal disclosures, reflecting the information needed for the Kentucky license renewal.
  • Ohio LPC License Renewal: Like the Kentucky form, Ohio's renewal application includes a certification statement and evidentiary requirements for continuing education.
  • New York LPC License Application: This application mirrors Kentucky's form by requesting detailed information about any previous sanctions, violations, or legal issues related to professional conduct.
  • Michigan LPC License Renewal: Michigan's requirements for license renewal include the submission of a fee and proof of continuing education, making it similar to the Ky LPCC License form process.

Dos and Don'ts

When filling out the Kentucky LPCC License form, keep these tips in mind:

  • Do: Double-check all personal information for accuracy.
  • Do: Submit your renewal application before the deadline to avoid complications.
  • Do: Include any supporting documents if you’re selected for an audit.
  • Do: Ensure payment is completed with a check or money order made out correctly.
  • Don’t: Ignore the requirement to cease the use of the title if your license is not renewed.
  • Don’t: Leave any sections of the form blank; complete every required field.
  • Don’t: Submit your form without signing it—your signature is essential.

Misconceptions

Many individuals misunderstand certain aspects of the Kentucky Licensed Professional Clinical Counselor (LPCC) license renewal process. Here are five common misconceptions:

  • Misconception 1: The license can be renewed after the deadline without penalties.
  • This is not true. Once the renewal period has passed on October 31, a grace period exists where the license can still be renewed, but a reduced fee of $25.00 applies. Failing to renew by December 31 results in termination of the license.

  • Misconception 2: Continuing education hours are not mandatory for renewal.
  • In fact, completing 10 hours of continuing education is required for license renewal. This applies regardless of whether an audit notice was received.

  • Misconception 3: You can continue using the LPCC title during the renewal process.
  • Once the license expires, you must immediately cease using the title Licensed Professional Clinical Counselor. There are no exceptions to this rule until the license is renewed.

  • Misconception 4: Submitting the renewal form is the only requirement for license renewal.
  • Submitting the renewal form along with the appropriate fee is necessary, but you also need to document continuing education hours if selected for an audit.

  • Misconception 5: There is no need to update personal information when renewing the license.
  • It is important to ensure that all personal details, including your current place of employment and contact information, are accurately filled out on the renewal form.

Key takeaways

Renewal Deadline: Remember that your Licensed Professional Clinical Counselor credential will expire on October 31, 2011. It’s crucial to submit your renewal form and fee by this date to avoid complications.

Fees: The standard renewal fee is $150.00. If you miss the initial deadline but renew within the 60-day grace period, your fee will be reduced to $25.00.

License Termination: Failing to renew by December 31, 2011, will lead to termination of your license. After that, you must cease using the title Licensed Professional Clinical Counselor in Kentucky immediately.

Continuing Education: If your renewal application indicates an audit selection, you must provide evidence of completing 10 hours of continuing education, as stipulated under 201 KAR 36:030.

Accurate Information: It's essential to answer all questions thoroughly and truthfully. Any misrepresentation can lead to disciplinary action against your license.

Supporting Documents: If applicable, submit separate sheets of paper for disclosing a felony conviction or any disciplinary actions you’ve encountered since your last renewal.

Signature Requirement: Don’t forget to sign your application. An unsiged form will delay your renewal process, and it’s essential to validate the information provided.