Fill - Free fillable Iowa Mental Health Counselor (MHC) (Center for Credentialing & Education) PDF form

Iowa MHC Education Review: revised 03/201

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 Mental Health Counselor (MHC)

This application form is interactive.

Download the form to your computer to ll it out.

Iowa MHC Education Review: revised 03/201

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 mental health counselor (MHC) with a qualifying

degree that was completed in any program other than a mental health counseling program accredited by the Council for

Accreditation of Counseling & Related Educational Programs (CACREP). 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 le 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 le. The le 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.

Iowa MHC Education Review: revised 03/201

IOWA MHC Education Review

Application

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 mental health

counselor (MHC) through the Iowa Board of Behavioral Science. Although my education program was not accredited

in mental health counseling by the Council for the Accreditation of Counseling & Related Educational Programs

(CACREP), I do meet all education requirements as dened for individuals who did not graduate from a CACREP-

accredited program or who graduated from a CACREP-accredited program in another eld.

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

mental health counseling in Iowa.

REF.#:_____________ AMOUNT: __________ BATCH #: __________ DATE: ____________

FOR OFFICE USE ONLY

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 V

oucher 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., counseling, clinical mental

health, addictions 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:

Iowa MHC Education Review: revised 03/201

1. 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 60 semester or 90 quarter hours of graduate-level

coursework including at least three semester hours or 4.5 quarter hours of graduate-level credit in each of the coursework

areas detailed below.For applicants who entered a program of study prior to July 1, 2013, 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 at

least three semester hours or equivalent hours of graduate-level credit in each of the coursework areas detailed below.

Have an ofcial sealed transcript from all graduate institutions attended (do not include undergraduate) sent directly from

the school to CCE.

Include coursework descriptions for the 10 core 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.

This form must be lled out in order for CCE to review your coursework. If CCE determines that a course does not t in a

particular category, it will review your transcript for other course possibilities.

REQUIRED COURSES (Please refer to pages 6-8 for detailed descriptions)

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.

COURSEWORK CATEGORIES

COURSE TITLE

COURSE

NUMBER

CREDIT

HOURS

INSTITUTION WHERE

COURSE WAS TAKEN

1. Professional Orientation

Studies that provide an understanding of all

aspects of professional functioning, including

history, roles, organizational structures, ethics,

standards and credentialing.

2. Social and Cultural Foundations

Studies that provide an understanding of

issues and trends in a multicultural and diverse

society.

3. Human Growth and Development

Studies that provide an understanding of

the nature and needs of individuals at all

developmental levels.

4. Career and Lifestyle Development

Studies that provide an understanding of career

development and the interrelationships among

work, family and other life factors.

IOWA MHC Education Review

Coursework Requirements Verication

Applicant’s Name:

Date:

Iowa MHC Education Review: revised 03/201

COURSEWORK CATEGORIES

COURSE TITLE

COURSE

NUMBER

CREDIT

HOURS

INSTITUTION WHERE

COURSE WAS TAKEN

8. Research and Program Evaluation

Studies that provide an understanding of types

of research methods, basic statistics, and

ethical and legal considerations in research.

9. Psychopathology

Studies that provide an understanding of the

description, classication and

diagnosis of behavior disorders and

dysfunction.

7. Diagnosis and Assessment Treatment

Procedures

Studies that provide an understanding

of individual and group approaches to

assessment and evaluation.

6. Groups

Studies that provide an understanding of

group development, dynamics, counseling

theories, and group counseling methods and

skills.

Practicum/Internship

See required attestation on page 9.

5. Helping Relationships

Studies that provide an understanding of

counseling and consultation processes.

10. Counseling Theories

Applicant’s Name:

Date:

Iowa MHC Education Review: revised 03/201

1. Professional Orientation

Studies that provide an understanding of all aspects of professional functioning, including history, roles,

organizational structures, ethics, standards and credentialing. Studies in this area include but are not limited to

the following:

1. History of the helping professions, including signicant factors and events;

2. Professional roles and functions, including similarities with and dierences from other types of professionals;

3. Professional organizations (primarily ACA, its divisions and its branches), including membership benets,

activities, services to members and current emphases;

Ethical standards of ACA and their evolution, legal issues, and applications to various professional activities (e.g.,

appraisal and group work);

Professional preparation standards and their evolution and current applications; and

6. Professional credentialing, including certication, licensure, and accreditation practices and standards, and the

eects of public policy on these issues.

2. Social and Cultural Foundations

Studies that provide an understanding of issues and trends in a multicultural and diverse society. Studies in this area

include but are not limited to the following:

Multicultural and pluralistic trends, including characteristics and concerns of diverse groups;

2. Attitudes and behavior based on factors such as age, race, religious preference, physical disability, sexual

orientation, ethnicity and culture, gender, socioeconomic status, and intellectual ability; and

Individual and group interventions with diverse populations.

3. Human Growth and Development

Studies that provide an understanding of the nature and needs of individuals at all developmental levels. Studies in

this area include but are not limited to the following:

1. eories of human development across the life span;

2. Major theories of personality development; and

3. Human behavior, including an understanding of developmental crises, disability, psychopathology, and cultural

factors as they aect both normal and abnormal behavior.

4. Career and Lifestyle Development

Studies that provide an understanding of career development and the interrelationships among work, family and

other life factors. Studies in this area include but are not limited to the following:

Career development theories and decision-making models;

2. Career, avocational, educational and labor market sources, print media, computer-assisted career guidance, and

computer-based career information;

Career development program planning;

4. Interrelationships among work, family, and other life factors such as multicultural and gender issues, as related to

career development;

Career and educational placement, follow-up and evaluation; and

6. Assessment instruments relevant to career planning and decision-making.

5. Helping Relationships

Studies that provide an understanding of counseling and consultation processes. Studies in this area include but are

not limited to the following:

Helping skills and counseling and consultation theories, including coverage of relevant research and factors

considered in applications;

DETAILED DESCRIPTIONS OF REQUIRED COURSE CONTENT

Iowa MHC Education Review: revised 03/201

2. Counselor or consultant characteristics and behaviors that inuence helping processes, including gender and

ethnicity dierences, verbal and nonverbal behaviors, and personal characteristics, orientations and skills; and

Client or consultee characteristics and behaviors that inuence helping processes, including gender and ethnicity

dierences, verbal and nonverbal behaviors, and personal characteristics, traits, capabilities, life circumstances

and developmental levels.

6. Groups

Studies that provide an understanding of group development, dynamics, counseling theories, and group counseling

methods and skills. Studies in this area include but are not limited to the following:

. Principles of group dynamics, including group process components, developmental stage theories, and group

members’ roles and behaviors;

. Group leadership styles and approaches, including characteristics of various types of group leaders and

leadership styles;

eories of group counseling, including commonalities, distinguishing characteristics, and pertinent research

and literature; and

Group counseling methods, including group counselor orientations and behaviors, ethical considerations,

appropriate selection criteria and methods, and methods of evaluation of eectiveness.

7. Diagnosis and Assessment Treatment Procedures

Studies that provide an understanding of individual and group approaches to assessment and evaluation. Studies in

this area include but are not limited to the following:

eoretical and historical bases for assessment techniques and methods of interpretation of appraisal data and

information;

Types of educational and psychological appraisal, as appropriate to the helping process;

3. Validity, including evidence for establishing content, construct and empirical validity;

4. Reliability, including methods of establishing stability and internal and equivalence reliability;

5. Major appraisal methods, including environmental assessment, performance assessment, individual and group

test and inventory methods, behavioral observations, and computer-managed and computer-assisted methods;

Psychometric statistics, including types of test scores, measures of central tendency, indices of variability,

standard errors and correlations; and

Gender, ethnicity, language, disability, and cultural factors related to the assessment and evaluation of individuals

and groups.

8. Research and Program Evaluation.

Studies that provide an understanding of types of research methods, basic statistics, and ethical and legal

considerations in research. Studies in this area include but are not limited to the following:

Basic types of research methods, including qualitative, quantitative-descriptive, and quantitative-descriptive-

experimental designs;

Basic statistics, including both univariate and bivariate hypothesis testing;

3. Uses of computers for data management and analyses; and

4. Ethical and legal considerations in research.

9. Psychopathology.

Studies that provide an understanding of the description, classication and diagnosis of behavior disorders and

dysfunction. Studies in this area include but are not limited to the following:

Study of cognitive, behavioral, physiological and interpersonal mechanisms for adapting to change and to

stressors;

Role of genetic, physiological, cognitive, environmental and interpersonal factors and their interactions on

Iowa MHC Education Review: revised 03/201

development of the form, severity, course and persistence of the various types of disorders and dysfunction;

Research methods and ndings pertinent to the description, classication, diagnosis, origin and course of

disorders and dysfunction;

eoretical perspectives relevant to the origin, development, course and outcome for the forms of behavior

disorders and dysfunction; and

Methods of intervention or prevention used to minimize and modify maladaptive behaviors, disruptive and

distressful cognition, or compromised interpersonal functioning associated with various forms of maladaptation.

Practicum/internship requirement for applicants who entered a program of study prior to July 1, 2013:

Supervised counseling internship must provide an opportunity for the trainee to perform under supervision a variety of

activities that a regularly employed sta member in a setting would be expected to perform. A regularly employed sta

member is dened as a person occupying the professional role to which the trainee is aspiring. e internship follows a

supervised practicum experience. A three-semester-hour internship includes the following:

A minimum of 120 hours of direct service with clientele appropriate to the program of study;

2. A minimum of one hour per week of individual supervision throughout the internship, usually performed by the

on-site supervisor;

A minimum of one and one-half hours per week of group supervision throughout the internship, usually performed

by a program faculty member supervisor.

For detailed information regarding the coursework, practicum and internship requirements for applicants entering

a program of study July 1, 2013 or after, refer to 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.

Iowa MHC Education Review: revised 03/201

By signing below, I attest that the practicum and/or internship courses indicated on the Coursework Requirements

Verication form of this application provided the required hours of supervised counseling eld experience as

dened in the detailed description of required course content and earned a minimum of six semester hours or nine

quarter hours of graduate-level credit.

IOWA MHC Education Review

Practicum and Internship Attestation

Applicant’s Name:

Date:

Signature:

Printed Name: Date:

Iowa MHC Education Review: revised 03/201

IOWA MHC Education Review

Payment Voucher

• 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.

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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