License/Certificate

Click below to learn about:
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	Administrative Rules
	The Application Process
	Approved Institutions
	Certified Clinical Supervisor
	Certified Clinical Supervisor Policy & Procedure
	Core Functions
	Exceptions - Reciprocity
	Prohibited Activities
	Practice Act 803
	Scope of Practice

Candidate Guides

	AODA Candidate Guide
	Case Presentation Method
	Advanced AODA
	Prevention Specialist

Here are descriptions and necessary forms for several types of certification.

You can either mail in your payment with your form or pay online. We will process your application/renewal once we have been notified of payment AND received your form via mail.

Important Notice

Licenses and Certificates
Licensed Addictions Counselor (LAC)	Description	Application
Certified Addictions Counselor (CAC)	Description	Application
Registered Addictions Counselor (RAC)	Description	Application
Certified Compulsive Gambling Counselor (CCGC)	Description	Application
Licensed Prevention Professional (LPP)	Description	Application
Certified Prevention Professional (CPP)	Description	Application
Registered Prevention Professional (RPP)	Description	Application
Counselor/Prevention Specialist in Training (CIT/PSIT)	Description	Application
Addiction Treatment Assistant (ATA)	Description	Application
Certified Clinical Supervisor (CCS)	Description	Application

Download

Licensed Addictions Counselor Application Packet

1. Cover Sheet	7. Code of Ethics
2. Instructions	8. Supervisor's Evaluation
3. Affidavit	9. Professional Reference
4. Personal Data	10. Renewal Application
5. Education History	11. Certification by Reciprocity
6. Employment History	12. Case Presentation & Cover page
	13. Supervised Practical Training form

Certified Addictions Counselor Application Packet

1. Cover Sheet	7. Code of Ethics
2. Instructions	8. Supervisor's Evaluation
3. Affidavit	9. Professional Reference
4. Personal Data	10. Renewal Application
5. Education History	11. Certification by Reciprocity
6. Employment History	12. Case Presentation & Cover page
	13. Supervised Practical Training form

Registered Addictions Counselor Application Packet

1. Cover Sheet	7. Code of Ethics
2. Instructions	8. Supervisor's Evaluation
3. Affidavit	9. Professional Reference
4. Personal Data	10. Renewal Application
5. Education History	11. Certification by Reciprocity
6. Employment History	12. Case Presentation & Cover page
	13. Supervised Practical Training form

Certified Compulsive Gambling Counselor

1. Cover Sheet	7. Employment History
2. Instructions	8. Code of Ethics
3. Affidavit	9. Supervisor's Evaluation
4. Personal Data	10. Professional References
5. Educational History	11. Renewal Application
6. CG Education

Licensed Prevention Professional

1. Cover Sheet	7. Employment History
2. Instructions	8. Prevention Experience
3. Affidavit	9. Code of Ethics
4. Personal Data	10. Supervisor's Evaluation
5. Educational History	11. Professional References
6. Prevention Education	12. Certification by Reciprocity
13. Renewal Application

Certified Prevention Professional

1. Cover Sheet	7. Employment History
2. Instructions	8. Prevention Experience
3. Affidavit	9. Code of Ethics
4. Personal Data	10. Supervisor's Evaluation
5. Educational History	11. Professional References
6. Prevention Education	12. Certification by Reciprocity
13. Renewal Application

Registered Prevention Professional

1. Cover Sheet	7. Employment History
2. Instructions	8. Prevention Experience
3. Affidavit	9. Code of Ethics
4. Personal Data	10. Supervisor's Evaluation
5. Educational History	11. Professional References
6. Prevention Education	12. Certification by Reciprocity
13. Renewal Application

Counselor/Prevention Specialist in Training Application Packet

CIT		PSIT
1. CIT Registration Form	6. CIT Renewal	1. PSIT Registration Form	5. PSIT Renewal
2. CIT Guidelines	7. CIT Core Functions & Global Criteria	2. PSIT Guidelines	6. Sample PSIT plan
3. Professional References	8. Sample CIT plan	3. Supervisor change form	7. Weekly Supervision Form
4. Supervisor change form	9. Weekly supervision form	4. PSIT-Performance Domains
	10. Code of Ethics
11. Betty Breen Memorial Foundation Please click here to visit the LASACT website for current forms and information.

Addictions Treatment Assistant

1. Application	3. Professional References
2. Code of Ethics	4. Renewal Application

Certified Clinical Supervisor

1. Certified Clinical Supervisor Application
2. Certified Clinical Supervisor Renewal
3. Professional References
4. Certified Clinical Supervisor Code of Ethics
Sample Audit Reports	AEPs
	AIHEs
	ATIs

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