APPLICATION FOR LPC CONTINUING EDUCATION CLOCK HOURS - Check Payment

For pre-approval of workshops for continuing education clock hours for LPC/PLPC license renewal, applications must be competed in its entirety and all supporting documentation attached. There is an opportunity to upload the presenter’s educational resume and the agenda/program. Fees must accompany the application. Fees are nonrefundable and do not guarantee approval.

If approved, the CE clock hours awarded may be used for LPCs and PLPCs for license renewal. This application does not serve the function of pre-approving for NBCC continuing education clock hours.

Fees may be paid be check. Fees should be mailed to 353 Leo, Shreveport, LA 71105. Fees should be paid within 30 days of application date.

*Required field(s) are indicated by an .**
Workshop Information
* Title of Workshop
Type of Workshop	Conference
	Live event
	Webinar
	Podcast
Platform	In Person
	Live Webinar
	Recorded Webinar
* Date of Workshop
Beginning Time
Ending Time
If in person, City
If in person, Venue Name
If in person, Address
Cost of Workshop
Total Number of Continuing Education Clock Hours Being Requested
CE clock hours for online activities must equal the active hours participants are engaged with the presenter. Which of the following content areas will this workshop address?
Counseling Theory
Ethics
Human Growth and Development
Marriage and Family
Social and Cultural Foundation
Chemical Dependency
The Helping Relationships
Supervision
Abnormal
Group Dynamics
Lifestyle and Career Development
Diagnosis
Appraisal of Individuals
Professional Orientation, Counselor Professional Identity and Practice Issues
Research and Evaluation
Please indicate how the content of this event will address the areas checked above	Be specific. DO NOT REFER THE REVIEWER TO AN ATTACHMENT.
Please indicate the learning objectives	DO NOT REFER THE REVIEWER TO AN ATTACHMENT
Upload Agenda/Program
Upon approval, this workshop will be advertised on the LCA website calendar	Please indicate a short description of this workshop
Is the workshop open to the public or is it an In-house Training which should not be entered on the calendar.	Place on the Calendar
	In-House Training
What contact information should be included on the calendar entry to request more information
How To Register For This Workshop (Include the link to the registration form.)	This is an in-house training and should not be entered on the calendar
About the Presenter Presenter 1
* Presenter 1 First Name
* Presenter 1 Last Name
* Degree/Credentials
Upload Presenter’s 1 Resume
Presenter 2
Presenter 2 First Name
Presenter 2 Last Name
Degree/Credentials
Upload Presenter’s 2 Resume
Presenter 3
Presenter 3 First Name
Presenter 3 Last Name
Degree/Credentials
Upload Presenter’s 3 Resume
About the Sponsoring Organization
Sponsoring Organization Name
Sponsoring Organization Address
Sponsoring Organization Phone
Sponsoring Organization Email
Sponsoring Organization Website
Have ever been approved by NBCC as an approved provider	Yes No
If yes, are you presently an NBCC ACEP	Yes No
If yes, what is the ACEP Number
Contact Person
Mailing Address
Phone
Email
Application Fees and Payment An administrative fee is required for each educational event and is due with the application. This fee is for the review of the application and does not guarantee approval. Please indicate which fees are applicable:
Application Fees	Single day workshop or online activity presented only one time.
	Single day workshop or online activity presented several times during one fiscal year.
	Conference (a workshop offered over continuous days)
Total
Fees may be paid be check. Fees should be mailed to 353 Leo, Shreveport, LA 71105. Fees should be paid within 30 days of application date.

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The Louisiana Counseling Association
353 Leo Avenue Shreveport
Louisiana, 71105

Phone: 318 861-0657
Fax: 318 868-3580
Email: help@therapygeek.com

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