Counselor Assessment Examination Registration Form
Register for the counselor assessment examination by providing your details and assessment preferences below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Professional Title
*
Area of Counseling Practice
*
Please Select
School Counseling
Mental Health Counseling
Career Counseling
Rehabilitation Counseling
Marriage and Family Counseling
Other
Preferred Assessment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Assessment Type
*
Written Examination
Oral Interview
Both Written and Oral
Years of Professional Counseling Experience
*
Self-Assessment: How confident do you feel about your readiness for this examination?
*
1
2
3
4
5
Please list any relevant certifications or training (optional)
Register
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