Fillable Colorado Addiction Counselor (CAC or LAC) Licensure by (Center for Credentialing & Education)

Fill Online, Printable, Fillable, Blank Colorado Addiction Counselor (CAC or LAC) Licensure by (Center for Credentialing & Education) Form

Use Fill to complete blank online CENTER FOR CREDENTIALING & EDUCATION pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Colorado Addiction Counselor (CAC or LAC) Licensure by (Center for Credentialing & Education)

On average this form takes 24 minutes to complete

The Colorado Addiction Counselor (CAC or LAC) Licensure by (Center for Credentialing & Education) form is 19 pages long and contains:

  • 0 signatures
  • 5 check-boxes
  • 94 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Center for Credentialing & Education forms online.

BROWSE CENTER FOR CREDENTIALING & EDUCATION FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
(For Addiction Counselor Currently Holding
Active Addiction License in Another State)
2019 Application
This application form is interactive.
Download the form to your computer to fill it out.
3 TERRACE WAY
GREENSBORO, NORTH CAROLINA 27403-3660 USA
TEL: 336-482-2856 * FAX: 336-482-2852
www.cce-global.org * cce@cce-global.org
The Center for Credentialing & Education, Inc. (CCE
) values diversity.
There are no barriers to certification on the basis of gender, race, creed, age, sexual orientation or national origin.
CCE and NBCC are registered trade and service marks of the National Board for Certified Counselors, Inc.
Colorado Addiction Counselor (CAC or LAC)
Licensure by Endorsement Review
2
The Center for Credentialing & Education, Inc. (CCE), on behalf of the state of Colorado, performs the
education equivalency review for licensed addiction counselor candidates. Any correspondence outside of the
education equivalency review should be directed to the state of Colorado at 303-894-7800.
CCE’s review is based on DHS Rule 21.330.83. Also see DHS 2 CCR 502-1. Colorado State Board of
Addiction Counselor Examiners Rules are available online at
https://www.colorado.gov/pacific/dora/Addiction_Counselor.
Applications will be held open for one year from the date of initial review. Please note that CCE cannot return or
duplicate an application. Prior to submitting your application to CCE, please make a copy of it for your records.
HOW TO CONTACT CCE
Telephone (toll-free): 888-817-8283
Telephone Hours: 8:30 a.m. to 5 p.m. Eastern time; 6:30 a.m. to 3 p.m. Mountain time (Monday–Friday)
E-mail: cce@cce-global.org
Fax: 336-482-2852
Send written correspondence to: CCE • 3 Terrace Way • Greensboro, NC 27403-3660
Reviews are conducted in order of receipt and completed within six weeks. Failure to include all required
items listed on page 3 will result in the need for additional reviews. Each subsequent review takes six weeks
from the date of document receipt.
In order to protect candidates from miscommunication or misinformation, CCE asks applicants to submit in
writing any questions regarding their education review. Questions can be sent via e-mail, postal mail or fax.
CCE responds to all questions in the order they are received.
As an applicant for licensure education review, you have the right to appeal the findings on the education
review completed by CCE. Please be aware that all applications for education equivalency review in Colorado
are reviewed by CCE, which is the contracted agent for the Colorado State Board of Addiction Counselor
Examiners, and the credential review is based on the Colorado Code of Law, Section 12-43-804 and Rule 14:
Colorado Board of Addiction Counselor Examiners Rules. These requirements must be met in full.
THREE COMPONENTS OF APPLICATION THAT MUST BE MET
(You must submit documentation as confirmation of meeting all three components)
• P
art I. Education/Training
• Part II. Experience in Addiction Counseling
• Part III. Exam (Specifically for Addiction Counseling)
CODE OF COLORADO REGULATIONS
Behavioral Health
2 CCR 502-1















 
 

  



Applicant Name: ______________________________________________
Last Name, First Name, Middle Initial
Email Address: _______________________________________________
Mailing Address: ______________________________________________
______________________________________________
SSN: ___________ ______________ __________________
Level of Certification or licensure applying for (check one):
C
AC I ________
CAC II ________
CAC III ________
LAC ________
Applicant must request official verification
of
active, current addiction counselor
licensure/certification/registration held in
another state.
Verifications should address all
requirements met
(education/training,
experience, examination). If
all
requirements are not verified, CCE may
accept
website printouts of requirements met.
Education Equivalency for Addiction Counselor Certification
When an applicant submits college courses on an application to the Center for Credentialing & Education
(CCE) in lieu of one of the required training classes, it is the applicant’s responsibility to demonstrate how their
college course is equivalent to the Office of Behavioral Health (OBH) approved core competencies for that
class. Anyone wishing to use college equivalents must submit the following to CCE:
1.
An official transcript from an accredited college or university in a sealed envelope. The courses must
be in a behavioral health science or field. Each college class being offered as the equivalent of a
CAC required class must have a grade of C or above.
2.
A cover letter with an attached syllabus and a written description about why the college class is
equivalent to the CAC required class.
3.
A college course must offer college credits that are equivalent or greater than the number of clock
hours required for the OBH training class.
College equivalency hours:
One semester credit hour = 15 clock hours
Two semester credit hours = 30 clock hours
Three semester credit hours = 45 clock hours
One quarter credit hour = 8.5 hours
Two quarter credit hours = 17 hours
Three quarter credit hours = 25.5 clock hours
CAC required classes that must be taken (no college course equivalency)
Client Record Management, 14 hrs.
Infectious Diseases in Addiction Treatment, 14 hrs.
Pharmacology I, 14 hrs.
Pharmacology II, 14 hrs.
Trauma Informed Care for Diverse Populations, 14 hrs.
Clinical Supervision I, 21 hrs.
Clinical Supervision II, 14 hrs.
CAC required classes that may have college equivalency (see core competencies posted on
the OBH website)
Addiction Counseling Skills, 21 hrs.
Principles of Addiction Treatment, 21 hrs.
Culturally Informed Treatment, 14 hrs.
Professional Ethics I: Ethics and Jurisprudence, 14 hrs.
Professional Ethics 1 1 , 14 hrs.
Motivational Interviewing, 21 hrs.
Cognitive-Behavioral Therapy, 14 hrs.
Clinical Assessment and Treatment Planning, 14 hrs.
Co-Occurring Disorders, 14 hrs.
Group Counseling Skills, 21 hrs.
Advanced Motivational Interviewing, 14 hrs.
Professional Practice, 7 hrs.
3
4
FORM A–COMPLETED CAC TRAINING/ EDUCATION
FORM A
(If you hold a Clinical Master’s or Doctorate degree, do not use this form. Use FORM B)
A
PPLICANT: It is your responsibility to ensure that you have completed the required coursework below or
have educational equivalency for your level. Refer to the CAC Handbook for Addiction Counselors, available at
www.cce-global.org/BusinessLicensureServices/StateLicensure.
> Complete this form to document all courses for the level for which you are applying.
> If you already hold a certification for previous level(s), you do not need to document those courses.
> Submit a copy of your certificate(s) for all courses you document on this form.
Training/Courses Training Date(s) Trainer Name (print)
CAC LEVEL I
Addiction Counseling Skills
Client Records Management
Principles of Addiction Treatment
Professional Ethics I (Ethics and Jurisprudence)
Culturally Informed Treatment
Infectious Diseases in Addiction Treatment
CAC LEVEL II
Document completion of all CAC Level II courses below. If you do not already hold CAC Level I certification, also
document CAC Level I courses above.
Motivational Interviewing
Cognitive Behavioral Therapy
Group Counseling Skills
Trauma Informed Care for Diverse Populations
CAC LEVEL Ill
Document completion of all CAC Level Ill courses below. If you do not already hold CAC Level I and/or II certification,
also document CAC Level I and/or II courses above.
Advanced Motivational Interviewing
Clinical Supervision II
Professional Practice
5
FORM B
FORM B–COMPLETED CAC TRAINING/EDUCATION
Clinical Master’s or Doctorate Degree Applicants
APPLICANT: It is your responsibility to ensure that you have completed the required coursework below or
have educational equivalency for your level. Refer to the CAC Handbook for Addiction Counselors, available at
www.cce-global.org/BusinessLicensureServices/StateLicensure.
> Document all courses completed on this form.
> Submit a copy of your certificate(s).
Training/Courses Training Date(s) Trainer Name (print)
CAC LEVEL II
Principles of Addiction Treatment
Infectious Diseases in Addiction Treatment
Pharmacology I
Pharmacology II
Motivational Interviewing
Group Counseling Skills
Professional Ethics II
CAC LEVEL Ill
Document completion of all CAC Level II courses above, plus the following :
Advanced Motivational Interviewing
Clinical Supervision I
Clinical Supervision II
For LAC by Endorsement Candidates
> Submit a copy of your active addiction counselor license.
> Provide training certificates to confirm you have met Colorado’s CAC Level III requirements.
> Include documentation of a passing score on the Examination for Master Addictions Counselors (EMAC).
6
Colorado Education Equivalency
Payment Voucher
PLEASE NOTE
• All fees must be paid in U.S. dollars.
• All fees are nonrefundable and nontransferable.
• Review results will be sent six weeks after application receipt.
• You will be notified in writing of your status and informed if further information is needed.
• Please make check or money order payable to CCE.
METHOD OF PAYMENT
Applicant’s Name:
Telephone: DAY:
EVENING:
□
Enclosed is a check or money order payable to CCE in the amount of $100.
□
Please charge the credit card listed below in the amount of $100.
Card Type: VISA MasterCard
American Express
Name on Card:
Account
Number:
Expiration
Date:
Card Security Code (from back of card):
Cardholder Signature: Date (mm/dd/yyyy):
SUBMIT YOUR APPLICATION AND PAYMENT
•
Mail: CCE; P.O. Box 63223; Charlotte, NC 28263-3223
• Fax: 336-482-2852
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Colorado Addiction Counselor (CAC or LAC) Licensure by (Center for Credentialing & Education)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document