Fillable Request For Re-Examination Form (Page 2 of 3) in pdf

Request For Re-Examination Form Page 2

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Applicant Name:

Last

First

Middle

NOTE: Knowingly providing false information or omitting pertinent information may be

grounds for denial of this application.

Signature of Applicant

Date

WAITING PERIOD FOR RETAKES

California Law and Ethics Exam: 90-day waiting period

LMFT Clinical Exam: 120-day waiting period

LEP Exam: 180-day waiting period

EXPEDITED PROCESSING – MILITARY SPOUSE/PARTNER AND HONORABLY

DISCHARGED VETERANS ONLY

The Board is required to expedite the licensure process for (1) an applicant who is a honorably

discharged veteran of the U.S. Armed Forces or (2) an applicant whose spouse or partner is an

active duty member of the U.S. Armed Forces and meets other criteria pursuant to BPC section

115.5. Download the request form from the Board’s website and include it ON TOP OF your Request

for Re-Examination form.

TESTING ACCOMMODATIONS

All exam sites are physically accessible to individuals with disabilities. Pursuant to the Americans

with Disabilities Act (ADA) and California law, the Board and its contracted testing vendor will provide

reasonable accommodations to candidates who have a qualifying disability or medical condition.

Accommodations will not be provided unless prior approval by the Board has been granted. The

processing time will vary depending on the volume of requests received. Request for

Accommodation forms and instructions are available on the Board’s website, or by contacting the

Board to have them mailed to you.

ABANDONMENT OF APPLICATION

In accordance with Title 16, California Code of Regulations section 1806, your file will be deemed

abandoned if:

• You fail to sit for the examination within one (1) year after being notified of eligibility to take the

examination;

• You fail to sit for the clinical examination within one (1) year of being notified of passing the

standard written or law and ethics examination; or,

• You fail to retake an exam within one (1) year from the date you were notified of failing the

examination.

To re-open an abandoned file, you must submit a new application, fee and all required

documentation, as well as meet all current requirements in effect at the time the new application is

submitted.

37A-298 (Revised 01/2017)

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Request For Re-Examination Form Page 2

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