Form 08-4403 - Professional Counselor Licensure Application - Juneau - 2013 Page 17
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18STATE OF ALASKA
BOARD OF PROFESSIONAL COUNSELORS
EDUCATIONAL COURSE WORK CHECK SHEET
Note: You must fill out this check sheet if you:
1) are not nationally or regionally accredited
and/or
2) your graduate degree is from a related field (related field includes psychology, marital and family therapy,
social work, and applied behavioral science)
Dear Applicant:
To assist the board in its review of your course work, please complete the following form and return it with your
application. Thank you for your assistance in this matter.
Please have your transcript(s) forwarded to the division directly from your school(s). To meet the requirements
of AS 08.29.110, an applicant’s degree must be from an institution that was regionally accredited at the time of
the applicant’s graduation (see 12 AAC 62.120(a)(1)-(7)). If the degree is not accredited the degree must include
course work in at least eight of the ten subjects listed (12 AAC 62.120(b)(1)-(10).
NAME OF APPLICANT:
UNIVERSITY/COLLEGE ATTENDED:
TYPE OF DEGREE:
DATE GRANTED:
All of the following requirements must be met to establish equivalency.
Instruction has been received in the following areas (you must have eight out of the ten):
1.
Helping relationship, including counseling theory and practice.
Yes
No
Institution
Course Number
Course Title
Dates
Credit
2.
Human growth and development.
Yes
No
Institution
Course Number
Course Title
Dates
Credit
3.
Lifestyle and career development.
Yes
No
Institution
Course Number
Course Title
Dates
Credit
4.
Group dynamics, processes, counseling, and consulting.
Yes
No
Institution
Course Number
Course Title
Dates
Credit
08-4403d
(Rev. 03/04/13)
Page 17
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