Form 08-4403 - Professional Counselor Licensure Application - Juneau - 2013 Page 13
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18STATE OF ALASKA
BOARD OF PROFESSIONAL COUNSELORS
LETTERS OF RECOMMENDATION
(Exam Applicants Only)
Required: Name of person you are requesting recommendation from
I am applying for a license to practice professional counseling in the State of Alaska. I am required to provide letters of
recommendation from professional counselors who are familiar with my work. Please provide the information requested
on this form and return completed form to:
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
Board of Professional Counselors
P.O. Box 110806
Juneau, Alaska 99811-0806
Signature of Applicant
Printed Name
Address
DO NOT DETACH
Note: Print or type legibly.
The letter of recommendation must come from a professional counselor who is familiar with the applicant’s work.
The professional counselor does not necessarily need to be licensed. In accordance with 12 AAC 62.990(c)(4),
“professional counselor” means a person who is in the practice of professional counseling as defined in AS
08.29.490(1).
I hereby certify that I have been professionally associated with
(Name of Applicant)
from
to
, and that I recommend the
applicant as being professionally capable, reliable, of good moral character and worthy of confidence.
Comment on the applicant’s qualifications, abilities, character, etc.
Note: Failure to complete this comments section may result in denial of licensure for the applicant.
Comments on the applicant’s qualifications, abilities, character, etc. should involve the practice of professional counseling
as defined in AS 08.29.490, which means the application of principles and methods, or procedures of the counseling
profession to diagnose or treat, other than through the use of projective testing or individually administered intelligence
tests, mental and emotional disorders that are referenced in the standard diagnostic nomenclature for individual, group,
and organizational therapy, whether cognitive, affective, or behavioral, within the context of human relationships and
systems.
The Practice of Professional counseling includes the professional application of evaluation techniques,
treatments and therapeutic services to individuals and groups for the purpose of treating the emotional and mental
disorders; an applied understanding of the dynamics of the individual and of group interactions, along with the application
of therapeutic and counseling techniques for the purpose of resolving intrapersonal and interpersonal conflict and
changing perceptions, attitudes, and behaviors in the area of human relationships. Administration and use of appropriate
assessment instruments that measure or diagnose problems or dysfunctions within the course of human growth and
development as part of a counseling process or in the development of a treatment plan.
08-4403b
(Rev. 03/04/13)
Page 13
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