The National Board for Certied Counselors, Inc. (NBCC) values diversity. There will be no barriers to certication on the basis of gender, race, creed, age, sexual orientation, or national origin.
8/2020
The National Board for Certied Counselors, Inc. (NBCC) values diversity. There will be no barriers to certication on the basis of gender, race, creed, age, sexual orientation, or national origin.
I, ___________________________________, hereby request that NBCC change the active status of my NCC certication
and specialty certications (if applicable) to reduced practice status. My signature below attests to the following:
1. I work less than 10 hours per week as a counselor, including clinical and volunteer work.
2. I agree to adhere to the guidelines regarding the reduced practice status option.
3. I understand this status change will also apply to any specialty certications that I hold.
4. I understand that as a reduced practice NCC, I must complete 10 hours of continuing education activities that meet
the NBCC requirements at the completion of the designated ve-year period.
5. I understand that if I allow my certication to lapse, I will be required to reinstate my certication. (Information
regarding NBCC’s reinstatement process can be found at ProCounselor.NBCC.org.)
6. I will continue to adhere to the NBCC Code of Ethics.
7. I will disclose to NBCC any charge, complaint, or conviction about a criminal, civil, state board, or other
professional disciplinary matter(s) within 60 days of occurrence.
8. I understand that all status change procedures and policies are subject to change.
9. I understand that I must continue to pay the annual certication fee and the fees for any specialty certications
(CCMHC, NCSC, and MAC).
10. I understand that in order to change my certication status, my account must be current on fees and I cannot be the
subject of any ethics review.
REQUEST FOR
“REDUCED PRACTICE” STATUS CHANGE
This form is interactive. Download the form to your computer to fill it out.
NBCC certication number: _________ Email address: __________________ Phone number: ____________________
Send form and fee payment to If no fees are due, send form to
Recertication Dept. Recertication Dept.
NBCC NBCC
P.O. Box 63160 3 Terrace Way
Charlotte, NC 28263-3160 Greensboro, NC 27403-3660
Signature: ____________________________________________________ Date: ____________
If a payment is required and you wish to submit this status change form via email, DO NOT complete the credit card
information on this page.
Check this box and email this form to recertication@nbcc.org. Please note that we cannot take payment via email.
We will reach out to you via email with instructions after receiving your form.
If a payment is required, mail your completed
form and past-due fees to:
NBCC Recertication Dept.
P.O. Box 63160
Charlotte, NC 28263-3160
If no payment is required, you may email your completed form to
recertication@nbcc.org, or mail your completed form to:
NBCC Recertication Dept.
3 Terrace Way
Greensboro, NC 27403-3660
Past-Due Fees Owed: $ _________
If you are unsure of your NCC status or past-due fees, log in to your ProCounselor account
or contact the Recertication Department at recertication@nbcc.org or 336-547-0607.
Cardholder Signature: _______________________________________________________ Date: ________________
☐ Enclosed is a check or money order made payable to NBCC in the amount of $
☐ Please charge the credit card as listed below in the amount of $
Card Number::
Expiration Date:
Name on Card:
Verication Code Numbers (from back of card):
Card Type:
VISA MasterCard
American Express
PAYMENT INFORMATION
FOR OFFICE USE ONLY
REF.#:__________ DATE: __________
BATCH#: ________ AMOUNT: ________
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