Forms

Email or Fax all forms except annual license renewal. The license renewal form is an online form, no ‘paper’ submissions of renewals.

EMAIL: [email protected]

FAX: 919-336-5156

.

• General Directions for All Forms
• Directions for Specific Sections
• Directions to Pay Form Fees
• Submit Form and Pay Forms Fees Here
• Links to Forms

General Directions for Forms

1. Email or Fax all forms except annual license renewal.
2. The license renewal form is an online form, no ‘paper’ submissions of renewals.
3. Forms that are mailed (i.e. USPS, FedEx, UPS) as hard copies will not be accepted.
4. Email Submission: Scan the completed form, payment receipt, and any additional required items as one PDF. Please do not send multiple pages, as this will take longer for your submission to be renewed.
5. Forms requiring payment, o to the section on this page Submit and Pay Form Fees Here. Select the appropriate form from the drop-down options and then attach the required documents. Choosing the appropriate category ensures proper processing and the correct fee (if any) associated with the form. Click submit and then you will be taken to the PayPal page to complete the transaction.
6. Though typed PDF forms are preferred you may print and complete the forms by hand using black ink only. Illegible forms may result in delayed processing.
7. Refer to the Calendar for submission deadlines, processing times and notifications, if applicable. For general requests, please allow 10 business days.

Directions for Specific Sections

1. Transcripts: Must be sent directly from the issuing institution (i.e. the university office or their designated transcript processing company) to the Board.
   • Have the university send transcripts to: [email protected] and the subject line “Transcripts.”
   • Name Changes: If the name on your transcript is different than the name on your application, documentation such as a copy of your marriage license, divorce decree, or court order, must be submitted with your application(s) for the National MFT Exam or any licensure application.
2. Endorsements: Should be emailed directly to the Board by the endorser from their email address.
   • Have the endorser email it to: [email protected] and the subject line “Endorsement for INSERT YOUR NAME HERE.”
   • Be sure they put your name as it is listed on your application, or it can not be accepted.
3. Supervision Reports: All supervision reporting forms must be sent directly from the supervisor’s email address.
   • Have the supervisor sent the completed and signed report to: [email protected] with your name and the name of the form as the subject line. For instance, a supervision report being submitted with a license application would have, “Jane Smith LMFTA Application Supervision Report” in the subject line, and a quarterly supervision report would have, “John Doe Quarterly Supervision Report” as the subject line.
   • Be sure all hours are submitted on the form, as applicants and licensees are unable to amend and add any additional clinical and/or supervision hours once the form has been submitted.
   • Be sure your name is listed as it appears on your application/license, or it can not be accepted.
4. Notarized Forms and Photos: Due to the current pandemic, circumstances warrant an alternative to provide proof of identity. Make a clear copy of your current driver’s license or other state issued identification, along with a current photo from a passport or other professional photo. Include this proof on a separate form behind your completed license application PDF.

Directions to Pay Form Fees

If your form requires payment, you will need to submit payment through PayPal. You do not have to have PayPal to submit a payment. You can use a debit or credit card, or your bank account information. Payments using bank account numbers will take longer to process, per bank/PayPal policies.

To make your payment, enter in your name, email address, the name of the form you are about to upload and submit later on the contact page, and then choose the amount from the drop-down menu. You will be taken to the PayPal page, where you will see the amount to pay in the upper right-hand corner. You may log-in to your PayPal account, or if you do not have a PayPal account (or you would like to pay with a debit/credit card), click on the gray box (as shown below in the image).

Links to Forms

Submit and Pay Form Fees Here

Thank you for your patience and continued support during this difficult time.