APPLICATION FOR
INITIAL LICENSE ISSUANCE
Instructions and Important Information
Read Carefully Before Completing Your Application
ELIGIBILITY FOR INITIAL LICENSE ISSUANCE AND TIME LIMIT
You must have passed the required examination(s) before your Application for Initial License
Issuance can be accepted by the Board.
You must apply and submit the initial license fee within one (1) year after you are
notified that you have successfully completed the examination requirements.
Otherwise your file will be considered abandoned and you will need to submit a new Application
for Licensure and fee, and meet all current requirements for licensure.
EXPEDITED REVIEW
The Board is required to expedite the licensure process for the following applicants who (1) meet all
of the requirements specified on the expedite form, and (2) include the expedite form with their
application (all expedite forms are also available at www.bbs.ca.gov>Applicants>Forms/Pubs):
o Honorably Discharged Veterans of the U.S. Armed Forces who meet the requirements of
Business and Professions Code (BPC) section 115.4. Download the request form from the
Board’s website and include it ON TOP OF your application.
o Spouses / Partners of Persons on Active Duty Military who meet the requirements of BPC
section 115.5. A $200 fee waiver is also available to these applicants. Download the request
form from the Board’s website and include it ON TOP OF your application.
o Refugees / Asylees / Special Immigrant Status Holders ("SI" or "SQ") who meet the
requirements of BPC section 135.4. Download the request form from the Board’s website and
include it ON TOP OF your application.
HOW TO APPLY
• APPLY ONLINE: If you were issued an Associate registration at any time in the past, for the
fastest processing you may submit your application and fee online at www.breeze.ca.gov. See
Breeze Helpful Hints for more information (access at www.bbs.ca.gov>Resources).
• APPLY VIA MAIL: If you have never had an Associate registration, or if you just want to mail
in your request, submit the attached print application. Allow up to 30 working days for
processing.
DCA BBS 37M-308 (Revised 03/2023) State of California
o FEE: Attach a $200 check or money order payable to “Behavioral Sciences Fund.”
o Submit your application and fee to the address below:
Board of Behavioral Sciences
1625 North Market Blvd., Suite S200
Sacramento CA 95834
TO CONFIRM RECEIPT OF APPLICATION
To confirm receipt, mail your application using a method that includes tracking. You may also
contact your bank to see if your check has been cashed.
ADDRESS OF RECORD OR EMAIL ADDRESS CHANGE
If your address of public record has changed, or if your email address (not disclosed to the public)
has changed, be sure to update it ASAP online at www.breeze.ca.gov.
APPLICATION PROCESSING TIME
Allow 30 working days for processing of the attached form. Apply online if you are eligible, for
faster processing (see “How to Apply”).
Once your request has been approved, your license will first issue online at www.breeze.ca.gov,
and then you will receive a license certificate in the mail. Once it has issued online, you are
officially licensed. Congratulations!
NOTICE ON COLLECTION OF PERSONAL INFORMATION
Please see the Notice on Collection of Personal Information (access at www.bbs.ca.gov>About
Us>About the Board>Policies).
QUESTIONS?
Please visit the Contact Us link at www.bbs.ca.gov and select an option under “Message the
Board.”
DCA BBS 37M-308 (Revised 03/2023) State of California
APPLICATION FOR
INITIAL LICENSE ISSUANCE
Office Use Only:
Carefully read the “Instructions and Important Information” FIRST
Attach $200 Fee Allow 30 Working Days for Processing
License Type (mark one): LMFT LPCC LCSW LEP
SSN or ITIN*:
Birth Date mm/dd/yyyy:
Legal Name**: Last First Middle
* You may provide either your Social Security Number, your Federal Employer Identification
Number, or Individual Taxpayer Identification Number, as applicable.
** You must use your legal name. Your “legal name” is the name established legally by your
birth certificate, marriage or domestic partnership certificate, or divorce decree (for example).
If you have a name change that you would like processed with your application, you must
attach the “Notification of Name Change” form and all required documentation. This form is
available online at https://www.bbs.ca.gov/pdf/forms/change_name.pdf.
Your license will reflect your new name only if a complete “Notification of Name Change” is
received with this application. Do not send original documents unless specifically requested.
I hereby confirm that I have passed the examination(s) required for licensure. I understand
that the Board may refuse to issue a license, or may suspend or revoke the license if the
applicant secures the license by fraud, deceit, or misrepresentation.
Signature of Applicant Date
DCA BBS 37M-308 (Revised 03/2023) State of California
