---
title: Licensed Professional Counselor (LPC) Application Form Template | Paperform
description: Complete LPC certification application form with supervised clinical hours tracking, case note uploads, NCE exam verification, and supervisor attestation. Streamline professional counselor licensure.
url: "https://paperform.co/templates/licensed-professional-counselor-lpc-application"
type: static
generatedAt: "2026-03-28T00:44:22.899Z"
---

[← Back to free form templates](/templates/)    ![Licensed Professional Counselor (LPC) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/licensed-professional-counselor-lpc-application.png)
    [Preview](https://_preview.paperform.co/ai-template/licensed-professional-counselor-lpc-application) [Use this template for free](/create?ai-template=licensed-professional-counselor-lpc-application)    [Application Forms](/templates/category/applications/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/)[Human Resources](/templates/industry/human-resources/) [Therapist](/templates/role/therapist/)[Counselor](/templates/role/counselor/)[Psychologist](/templates/role/psychologist/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Licensed Professional Counselor (LPC) Application Form

Becoming a Licensed Professional Counselor is a significant milestone in your counseling career, and the application process requires meticulous documentation of your clinical experience, supervision hours, and professional competencies. This **Licensed Professional Counselor (LPC) Application** template streamlines the entire certification process, making it easier for mental health professionals to compile and submit their credentials to state licensing boards.

#### Why This LPC Application Template Matters

For mental health professionals, counseling supervisors, and state licensing boards, managing the LPC application process can be complex and time-consuming. Applicants must document thousands of supervised clinical hours, provide detailed case note samples, verify exam completion, and demonstrate compliance with specific state requirements—all while maintaining accuracy and professionalism.

This Paperform template transforms a traditionally paper-heavy, error-prone process into a streamlined digital experience. Applicants can complete their application at their own pace, upload supporting documents securely, and ensure all required information is captured before submission. For licensing boards and professional associations, this means receiving complete, well-organized applications that are easier to review and process.

#### Built for Mental Health Professionals and Licensing Bodies

This form template is specifically designed for:

 - **Counseling graduates** completing their post-graduate supervised clinical hours
 - **Licensed Professional Counselor Associates (LPC-A)** applying for full licensure
 - **Clinical supervisors** who need to verify and sign off on supervised hours
 - **State licensing boards** managing LPC certification applications
 - **Professional counseling associations** offering certification programs
 - **Educational institutions** supporting graduates through the licensure process

#### What's Included in This Template

The LPC application form includes comprehensive sections covering all standard certification requirements:

**Applicant Information & Credentials** Capture personal details, educational background, degree verification, and graduate program accreditation status. The form collects information about counseling specializations, theoretical orientations, and professional memberships.

**Supervised Clinical Hours Breakdown** Detailed tracking of supervised clinical hours across multiple categories including direct client contact hours, individual supervision, group supervision, and indirect clinical activities. The form uses calculated fields to automatically total hours and verify they meet minimum requirements.

**Clinical Experience Documentation** Document your clinical placements, internship sites, and post-graduate employment settings. Include information about your clinical supervisors, their credentials, and the nature of your clinical work with different populations.

**Case Note Samples & Clinical Documentation** Securely upload de-identified case note samples demonstrating your clinical documentation skills, assessment capabilities, treatment planning, and therapeutic interventions. The form supports multiple file uploads with clear instructions for maintaining client confidentiality.

**NCE Exam Verification** Provide your National Counselor Examination (NCE) or National Clinical Mental Health Counseling Examination (NCMHCE) completion details, including exam date, score, and verification number.

**Supervision Verification & Attestation** Digital signature fields for clinical supervisors to verify supervised hours and attest to your clinical competency. This eliminates the need for wet signatures and mailed verification forms.

**Professional References & Ethics** Collect professional references from supervisors and colleagues, along with ethics attestations and disclosure of any disciplinary actions or legal issues.

#### Streamline Certification with Paperform's Powerful Features

This template leverages Paperform's advanced capabilities to create a professional, user-friendly application experience:

**Conditional Logic for State-Specific Requirements** Different states have varying LPC requirements. Use conditional logic to show or hide specific questions based on the applicant's state, ensuring they only see relevant requirements and provide the correct documentation.

**Automatic Calculations for Hour Tracking** Built-in calculation fields automatically total supervised hours across categories, helping applicants verify they've met minimum requirements before submission and reducing processing time for licensing boards.

**Secure Document Upload** Upload transcripts, case notes, supervision agreements, and proof of exam completion directly within the form. All files are stored securely and linked to the application for easy review.

**Progress Saving** Applicants can save their progress and return to complete the application over multiple sessions—essential for a comprehensive application that requires gathering documents from multiple sources.

**Digital Signatures with Papersign** Connect this form to [Papersign](https://papersign.com) to send supervision verification agreements and attestation forms for legally binding eSignatures. Supervisors can review and sign verification documents remotely, eliminating delays caused by mailing physical forms.

**Automated Workflows with Stepper** Use [Stepper](https://stepper.io) to automate what happens after submission. Route applications to the appropriate review committee, send confirmation emails to applicants, notify supervisors to complete verification forms, update your applicant tracking system, and create follow-up tasks for incomplete applications—all without manual intervention.

#### Perfect for Professional Services and Healthcare Organizations

Mental health organizations, professional associations, and state licensing boards can customize this template to match their specific certification standards. Add your organization's branding, modify hour requirements to match state regulations, include additional specialization categories, or integrate with your existing practice management and credentialing systems.

For private practice groups and counseling agencies, this template can be adapted for internal credentialing processes, privileging decisions, or verifying staff qualifications for insurance paneling.

#### SOC 2 Compliant and Secure

Paperform is **SOC 2 Type II compliant**, ensuring that sensitive applicant information—including case notes, exam scores, and personal credentials—is protected with enterprise-grade security. Data residency controls and role-based permissions mean you can manage applications confidently, knowing you're meeting professional standards for confidential information handling.

#### Get Started in Minutes

This LPC application template is ready to use immediately. Simply customize the state-specific requirements, adjust hour categories to match your licensing board's standards, add your organization's logo and branding, and start accepting applications. Whether you're processing five applications or five hundred, Paperform scales with your needs while maintaining the professional, user-friendly experience that both applicants and reviewers expect.

Start your path to professional counselor licensure with a streamlined, professional application process that respects the complexity of clinical credentialing while making it accessible and efficient for everyone involved.
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