**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1
Do you have 60 credit hours from an accredited college or university with a minimum of 12 credit hours in mental health, health, human services, education, or related behavioral sciences including six (6) credit hours in psychology, counseling, addictions or mental health? Please attach transcript to application. Unofficial transcripts acceptable.
Yes
No
2
If yes, please list the required coursework (twelve credit hours in mental health, health, human services, education, or related behavioral sciences including six credit hours in psychology, counseling, addictions or mental health) in the space below using the following format. If no, please indicate N/A. You must also attach a copy of your official or unofficial transcripts to your application:
Example: Course Number Title Credits Earned
PSY 101 Introduction to Psychology 3.0
*This information will be verified upon employment.