VERIFICATION OF NATIONAL CERTIFIED COUNSELOR (NCC) STATUS (an electronic or paper copy of your certificate can be sent in lieu of this form)

NOTE: Applicant may submit photocopy of NCC certificate in lieu of this form.

I have applied to the National Credentialing Academy for Certified Family Therapists and am required to provide verification of my certification as a National Certified Counselor (NCC). Please complete the information requested below and mail the form directly to NCA at the address listed below. My application cannot be processed until this form is received.