**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.**
Are you currently licensed by the Maryland State Board of Professional Counselors and Therapists as a Clinical Professional Art Therapist (LCPAT)? If yes, please attach a copy of your license.
If you answered Yes to the previous question, please provide the license number and expiration date in the box below. A copy of your current license or license verification should also accompany your application.