Fillable Request for Verification of Exam Score (North Carolina Board of Licensed Clinical Mental Health Counselors)

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Request for Verification of Exam Score (North Carolina Board of Licensed Clinical Mental Health Counselors)

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Certified Rehabilitation Counselor Exam
Request for Verification of Exam Score
Mail to: Commission on Rehabilitation Counselor Certification
1699 East Woodfield Road, Suite 300
Schaumburg, IL 60173
From: _________________________________________________________________________
Name of Applicant
Address: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Telephone: ____________________________________________________________________
Date of Exam: _____________________ State: ______________________________
I have applied for licensure to the North Carolina Board of Licensed Clinical
Mental Health Counselors and am required to provide documentation of my
Certified Rehabilitation Counselor Examination score. Please send a copy of my
official score report to the North Carolina Board of Licensed Clinical Mental
Health Counselors:
NCBLCMHC
P.O. Box 77819
Greensboro, NC 27417
I have enclosed a check for $25.00 to cover the cost of sending my score report
to the North Carolina Board of Licensed Clinical Mental Health Counselors.
__________
______________________ _______________ __________
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Request for Verification of Exam Score (North Carolina Board of Licensed Clinical Mental Health Counselors)

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Completed 4 September 2021

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