Approved TeleSupervisor (ATS)
Initial Application

Contact Details

Prefix

First Name *

Middle Name

Last Name *

Suffix

Personal Email *

Mobile Phone Number *

I would like to receive Text Messages related to my certification(s). I understand that I can reply STOP at any time to unsubscribe.

Mailing Address *

Mailing City *

Mailing State *

Mailing Country *

Mailing Zip Code *

Education & Professional Achievements

University Name *

Please Select the High Degree You've Achieved *

Please Specify the Degree Program/Major/Field of Study *

LPC License Issued Date *

LPC License Number *

Please upload your ATS exam completion certificate. *

Acknowledgment & Attestation Statements

I attest that I have read and agree to the following:

My application is subject to the rules, bylaws, and other governing provisions of CCALP.
I agree to abide by the policies and regulations of CCALP.
I agree to surrender my certification/candidacy if found in violation of the above by CCALP.

By my signature, I attest that the information I submit herein or in any required accompanying or subsequent documentation is true and accurate to the best of my knowledge. I understand that persons who apply for certification are subject to CCALP’s eligibility requirements for certification and recertification. *

Clear

Certification Fee *

Approved TeleSupervisor (ATS) Certification

$175