CREDENTIAL APPLICATION FOR N CERTIFIED ADOLESCENT 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Personal Data section. Fill in your title (Dr., Mr., Ms., etc.), full name, address, phone numbers, and email. If applicable, include documentation for any name changes.
3. Proceed to Payment/Fee Information. Enter the application fee amount and select your payment method. Ensure you provide the cardholder's name, credit card number, expiration date, and signature.
4. In the Credential Eligibility section, confirm that you meet all requirements. Attach necessary documents such as transcripts and proof of current credentials.
5. Complete the Career History section by listing your employment history relevant to Substance Use Disorders/Addiction counseling.
6. Have your supervisor complete the verification sections (VII-a and VII-b) regarding your work experience with adolescents.
7. Finally, sign the Candidate’s Affirmation and ensure all required documents are included before mailing your application.

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