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If submitting forms to the MS LPC Board Office, please be certain to use the Jackson, MS, address listed below. | |
- Fee Schedule
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Application for LPC **Revised 2.19.15 
- Paper
 Online application is preferred and faster method. Paper version is for reference.
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- Online
 Before you proceed to the online application you should print and review the paper application to ensure that you have all the documentation that is required.-
Post-Graduate Supervisory Agreement Form
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- Online
- The online process creates your profile and uses electronic signatures to complete the agreement. Instructions
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Supervision Reporting Form
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- Paper
- This is a sample reporting log. Supervisors may utilize their own forms to facilitate the tracking process with supervisees.
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- Online
- When the counselors that you are supervising have been added to your profile, you can login and prepare the reporting form online. Instructions
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Application for Board Qualified Supervisor (BQS)
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- Paper
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- Online
- Instructions
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Complaint Form
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- Paper
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- Online
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- Verification of Licensure in Other Jurisdiction
- If you are applying for licensure in MS and currently hold a license in another state, submit this form to the state where you hold a license to practice Professional Counseling.
- Mississippi does not have a reciprocal agreement with other states; therefore you must meet all MS requirements. You must also complete the MS application and submit along with the application ALL supporting documents. (i.e. supervision verification forms, transcripts, scores, etc.)
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- Verification of MS Professional Counselor License
- Request for Verification of License
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- Request for Mailing Labels
- The MS LPC Board will no longer offer mailing lists for purchase.
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- Address Change Form (Can now be made in your profile. - Login)
- Use this form to change address, phone, or email.
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- Name Change Request
- Use this form to request name change on license.
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- Replacement Wall Certificate Request
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- CE Hours Reporting Form (Can now be reported in your profile. - Login)
- Please visit the “Education” tab when you login to your profile to report CEH or please fill out and print this paper form. You can save the data you've typed. Return with renewal form and fee.
- For helpful hints, open the yellow sticky notes on the file when open.
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- 2015 License Renewal Form
- This is the paper form for renewal. Must be accompanied with CEH Reporting Form and payment when mailed in.
You may also login and renew online.
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- Lapsed 2014 License Renewal Form
- You must use this form if your license lapsed June 30, 2014.
Contact the LPC Board Office if your license lapsed prior to 2014.
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- Lapsed 2012 or 2013 License Renewal Form
- You must use this form if your license lapsed June 30, 2013 or 2012.
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