Canadian Certified Counsellor (CCC)
Application Form
(All applicants must be a member of CCPA in order to apply for certification)
INCOMPLETE FORMS WILL NOT BE PROCESSED
CCPA_CCCAPP_02_2022
1. Applicant Information
First Name: Last Name:
Other Legal Names:
Number and Street:
City, Province, Postal code:
CCPA Member #:
Home Phone: Cell Phone: Work Phone:
email:
2. Education (Must hold a graduate degree in counselling or related field)
University Year Degree Major
1.
2.
Graduate
Degree (s)
3. Graduate-level coursework toward certification (located on transcript(s), minimum 8 full courses):
Course Code Course Title Semester Completed
Counselling Theory (Compulsory)
Supervised Counselling Practicum/Internship (Compulsory)
Counselling & Communication Skills (Compulsory for graduates after Sept 2012)
Professional Ethics (Compulsory for graduates after Sept 2012)
3. Elective Courses (please refer to the corresponding section in the Certification Guide)
1.
2.
3.
4.
Continued on next page
5.
6.
4. Documentation: All applicants must provide each of the following pieces of documentation. Please check off each
document that you have prepared or intend to submit
Official transcript
Sent to CCPA by mail in a signed and sealed envelope from the university, or emailed directly from the issuing
university as a password-protected unalterable PDF document to CCPA National office. Electronic copies of the
transcript from the applicant, mailed transcripts with a broken or tampered seal, any type of faxed transcripts,
scanned, or photocopied versions of the official transcript will not be accepted toward certification as the
authenticity of these documents cannot be verified.
Course descriptions from an official source
These must be official syllabi or course descriptions from the academic course calendar from the years that you
attended your Masters of Counselling. Normally, these documents can be obtained from the university
registrar's office. These documents may be photocopied or scanned and sent to us by mail or fax, or sent by
email in an unalterable PDF (including URL and retrieval date information if it is saved from the official
university website).Applicants who cannot obtain an official document can ask their University for archived
copies. If archives are unavailable, the University must provide a letter attesting that they are no longer
available in order for your application to be evaluated.
Vulnerable Sector Criminal Record Check
The original hardcopy, issued by the police within the past 12 months, must be mailed to CCPA from the
applicant, or sent directly from the issuing police service by email as a password-protected unalterable PDF
document. Electronic copies from the applicant, faxed documents, scanned, or photocopied versions of the
check will not be accepted toward certification as the authenticity of these documents cannot be verified.
5. Pathways Documentation: All applicants must apply based on either Pathway ONE or Pathway TWO.
CCC Practicum Form(s) One form per practicum placement. Altogether the forms must attest to a total of 150
hours of direct client counselling.
PATHWAY ONE, for applicants who graduated within the last five years. Education and Practicum Training:
TWO CCC Reference Forms: Must be completed by a graduate-level counsellor, counsellor-educator, or
counselling supervisor. The individual must be someone in a non-compliant relationship with you.
CCC Work Experience Form(s)
One form per employer/workplace. In total, Attesting to 800 hours of direct client counselling (the equivalent of 3 years
of practice) within the last five years from the date of their application.
Current résumé.
TWO CCC Reference Forms
One of which must be completed by a clinical supervisor who has engaged in formal supervisory activities
according to CCC criteria and can speak to the applicant's competencies. Forms must be completed by a
graduate-level counsellor, counsellor-educator, or counselling supervisor. The individual must be in a non-
compliant relationship with you who knows you in your capacity as a counsellor within the past ten years.
PATHWAY TWO, for applicants who graduated over five years ago. Education and Work Experience:
Or
6. Attestation: Please read carefully for important information regarding your application
I certify that the information provided in this application is accurate and complete to the best of my knowledge and
belief. I understand that the outcome of my application depends upon my demonstration of how my application
satisfies the required criteria, including presenting relevant coursework in Section 3 for consideration by the
Registrar. I will practice in accordance with CCPA's Code of Ethics. I have included a valid criminal records check with
vulnerable sector screening conducted within the last 12 months or will submit one to CCPA shortly. I understand
that any certification granted to me by the Canadian Counselling and Psychotherapy Association does not in and of
itself specify licensure to practice counselling for a fee, monetary or otherwise. If I am granted certification by CCPA
and practice counselling as a private practitioner, I do so at my own risk. I hereby release CCPA from any and all
liability and/or claim that may arise from any decisions to practice privately as a Canadian Certified Counsellor. For
research and statistical purposes only, data resulting from my participation in this process may be used in an
unidentifiable manner.
I understand that all material becomes the property of CCPA upon receipt and that the official versions of my
transcript and vulnerable sector criminal record check will be destroyed 12 months after I receive the Registrar's
outcome. If I want these documents back, I understand that I must request to have them sent free of charge prior to
the end of this timeframe.
*Applicant signature: *Date:
Please send the form by Mail/Fax/Email to:
Canadian Counselling and Psychotherapy Association
202 - 245 Menten Place
Ottawa, ON, K2H 9E8
Fax: 613-237-9786
E-Mail:
certification@ccpa-accp.ca
Payment can be made online by logging into the Member Portal at https://members.ccpa-accp.ca.
The total cost for certification is $170 ($95 for application plus $75 annual fee). The $75 annual fee will be
reimbursed if your application is not granted CCC.
7.Payment
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