Fillable Iowa Marital and Family Therapist (MFT) (Center for Credentialing & Education)

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Iowa Marital and Family Therapist (MFT) (Center for Credentialing & Education)

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1
Iowa MFT Education Review: revised 03/2019
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 certication 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 Certied Counselors, Inc.
2019 Application for Education Review
Iowa Marital and Family Therapist (MFT)
This application form is interactive.
Download the form to your computer to ll it out.
2
Iowa MFT Education Review: revised 03/201
9
The Center for Credentialing & Education, Inc. (CCE), on behalf of the Iowa Board of Behavioral Science, performs the
initial education review for individuals applying for licensure as a marital and family therapist (MFT) with a qualifying
degree that was completed in any program not accredited by the Commission on Accreditation for Marriage and Family
Therapy Education (COAMFTE). Questions about licensure that do not relate to the education review should be directed
to the Iowa Board of Behavioral Science. The board can be contacted by telephone at 515-281-4422 or by visiting www.
idph.state.ia.us/contact_us.asp and following the e-mail instructions.
CCE’s review is based on 645 Iowa Administrative Code, Chapter 31 (154D) (Licensure of Marital
and Family Therapists
and Mental Health Counselors), available at https://www.legis.iowa.gov/docs/ACO/chapter/645.31.pdf.
Education review applications will be held open for three years from the date of initial receipt by CCE. During this
time, applicants will have the opportunity to rectify any deciencies. 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.
If coursework was completed at a school outside the United States, please contact the Iowa Board of Behavioral
Science at 515-281-4422 regarding educational review.
HOW TO CONTACT CCE
Telephone (toll-free): 888-817-8283
Telephone Hours: 8:30 a.m. to 5 p.m. Eastern time; 7:30 a.m. to 4 p.m. Central time (Monday–Friday)
E-mail: cce@cce-global.org
Fax: 336-482-2852
Send written correspondence to: CCE • Attn: Iowa Review • 3 Terrace Way • Greensboro, NC 27403-3660
Reviews are conducted in order of receipt and completed within six weeks. Applicants are notified of review
results via postal mail.
Delays result from incomplete applications.
Every applicant’s file is reviewed within six weeks of receipt. If the
review reveals that additional documentation will be necessary to determine whether the applicant’s education meets the
requirements, the applicant is sent a letter explaining what is needed to complete the review. When additional
documentation arrives, it is added to the applicant’s file. The file is then returned to queue to be reviewed. The review
will occur within six weeks of receipt of the additional documentation.
After receiving written notication of review results, applicants are asked to submit any follow-up questions in writing.
This helps provide clear communications. Questions may be sent via e-mail, postal mail, or fax. CCE responds to all
questions in the order of receipt.
Applicants for education review have the right to appeal CCE’s nal decision, which is provided to the applicant in
writing after all required documentation has been reviewed. Appeals are sent to CCE and forwarded with the applicant’s
le to the Iowa Board of Behavioral Science. CCE is a contracted agent for the Iowa Board of Behavioral Science. CCE’s
review is based on 645 Iowa Administrative Code, Chapter 31 (154D). Requirements, as required by law, stated in the
rules and reected in this application, must be met in full. After receiving notication that the appeal has been forwarded
to the Iowa board ofce, an applicant who wishes to attend the appeal review meeting may contact the Iowa board ofce
directly for information about the date and location of the meeting.
3
Iowa MFT Education Review: revised 03/2019
IOWA MFT Education Review
Application
INSTRUCTIONS AND REQUIRED ITEMS
1. Type or clearly print all information. Complete all sections.
2. Sealed, official graduate transcripts are required.These must be sent directly from your school to CCE.
3. Course descriptions are required. (See #3 at the top of page 4.)
4. Complete the Payment Voucher with your credit card information or attach a personal check, certified check or money order
for $150 payable to CCE.
Graduate Degree
(e.g. M.A., M.S., Ph.D.)
Name of
College/University
Date Degree
Conferred
Major Study
(e.g.,marriage and family
therapy, counseling)
Number of Credit
Hours Received
(Indicate semester or quarter hours)
7. Education (please document additional related degrees on a separate sheet and include with application materials):
1. Name:
Please list any other names used on transcripts:
2. Mailing Address:
3. Home Telephone: Business Telephone:
4. E-mail Address:
5. Gender: ____ Male ____ Female 6. Last Four Digits of Social Security Number:
Applicant’s Signature: ______________________________________________________________ Date: ______________________
8. Applicant Attestation:
a. I have read and understand the laws and rules applicable to the education requirements for licensure as a marriage
and family therapist (MFT) through the Iowa Board of Behavioral Science. Although my education program was not
accredited in mental health counseling by the Commission on Accreditation for Marriage and Family Therapy Education
(COAMFTE), I do meet all education requirements as dened for individuals who did not graduate from a COAMFTE-
accredited marital and family therapy program.
b. I understand that my review cannot be completed until all required documents and any requested additional
documentation is received by CCE. I also understand that if I disagree with CCE’s nal decision, I have the right to
appeal CCE’s decision to the Iowa Board of Behavioral Science.
c. I, ______________________________________, am the person described and identied, of good moral character, and
the person named in all documents presented in support of this application. I have carefully read the questions in the foregoing
application and have answered them completely, without reservations of any kind, and I declare that all statements made by me
herein are true and correct. Should I furnish any false or incomplete information in this application, I hereby agree that such
act shall constitute the cause for denial or revocation of my license to practice marital and family therapy in Iowa.
REF.#:_____________ AMOUNT: __________ BATCH #: __________ DATE: ____________
FOR OFFICE USE ONLY
4
Iowa MFT Education Review: revised 03/201
9
COURSEWORK CATEGORIES
COURSE TITLE
COURSE
NUMBER
CREDIT
HOURS
INSTITUTION WHERE
COURSE WAS TAKEN
1. At least nine semester hours or the equivalent
in each of the three areas listed below:
(1) Theoretical foundations of marital and family
therapy systems: Any course that deals primarily
in areas such as family life cycle, theories of family
development, marriage or the family, sociology of
the family, families under stress, the contemporary
family, family in a social context, the cross-
cultural family, youth/adult/aging and the family,
family subsystems, and individual interpersonal
relationships (marital, parental, sibling)
(2) Assessment and treatment in family and marital
therapy: Any course that deals primarily in areas
such as family therapy methodology; family
assessment; treatment and intervention methods; and
overview of major clinical theories of marital and
family therapy, such as communications, contextual,
experiential, object relations, strategic, structural,
systemic and transgenerational
(3) Human development: Any course that deals
primarily in areas such as human development,
personality theory and human sexuality (One course
must be psychopathology.)
continued on page 4
IOWA MFT Education Review
Coursework Requirements Verication
Applicant’s Name:
Date:
1. This application requires completion of a master’s or doctoral degree in mental health, behavioral science, or a counseling-
related field from a college or university accredited by an agency recognized by the United States Department of Education
and at least 60 semester or 80 quarter hours of graduate-level coursework including the specified number of graduate-level
credit hours in each of the coursework areas detailed below. For applicants who entered a program of study prior to July
1,
2010, this application requires completion of a master’s or doctoral degree from a college or university accredited by an
agency recognized by the United States Department of Education and at least 45 semester hours or 60 quarter hours of
graduate-level coursework including the specified number of graduate-level credit hours in each of the coursework areas
detailed below
.
2. Have an official sealed transcript from all graduate institutions attended (do not include undergraduate) sent directly from
the school to CCE.
3. Include coursework descriptions for the coursework requirements and practicum/internship. Coursework descriptions must
be photocopied from the catalogue for the year in which the courses were taken. Course descriptions typed by the applicant
will not be accepted.
4. This form must be filled out in order for CCE to review your coursework.
If CCE determines that a course does not fit in a
particular category, it will review your transcript for other course possibilities.
REQUIRED COURSES
If you have taught a graduate-level course at a college or university accredited by an agency recognized by the United States
Department of Education, that class may be accepted to satisfy a coursework area. Applicants wishing to satisfy a requirement
in this way must submit a syllabus from the semester the course was taught along with a letter of attestation from the department
head. The letter must be on university letterhead.
5
Iowa MFT Education Review: revised 03/2019
COURSEWORK CATEGORIES
COURSE TITLE
COURSE
NUMBER
CREDIT
HOURS
INSTITUTION WHERE
COURSE WAS TAKEN
Practicum/Internship
A graduate-level clinical practicum in marital and
family therapy of at least 300 clock hours is required
for all applicants.
An original signature is required on the
attestation statement below.
2. At least three semester hours or the equivalent
in each of the two areas listed below:
(1) Ethics and professional studies: Any course
that deals primarily in areas such as professional
socialization and the role of the professional
organization, legal responsibilities and liabilities,
independent practice and interprofessional
cooperation, ethical issues in marital and family
counseling, and family law
(2) Research: Any course that deals primarily in areas
such as research design, methods and statistics and
research in marital and family studies and therapy
By signing below, I attest that the practicum and/or internship courses indicated on the Coursework Requirements
Verication form of this application provided at least 300 hours of marital and family therapy eld experience
and earned graduate-level credit.
PRACTICUM AND INTERNSHIP ATTESTATION
Signature:
Printed Name: Date:
Applicant’s Name:
Date:
6
Iowa MFT Education Review: revised 03/201
9
• 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 notied in writing of your status and informed if further information is needed.
• Please make check or money order payable to CCE.
IOWA MFT Education Review
Payment Voucher
METHOD OF PAYMENT
Telephone: DAY:
EVENING:
Applicant’s Name:
□ Enclosed is a check or money order payable to CCE in the amount of $150.
□ Please charge the credit card listed below in the amount of $150.
Cardholder Signature: ______________________________________ Date
(mm/dd/yyyy): ____________
Account
Number:
Card Security Code (from back of card):
Name on Card:
Card Type:
VISA
MasterCard
American Express
Expiration
Date:
SUBMIT YOUR APPLICATION AND PAYMENT
• Mail: CCE; P.O. Box 63223; Charlotte, NC 28263-3223
• Fax: 336-482-2852
PLEASE NOTE
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Completed 26 May 2021

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