Form online 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and credential number in the designated fields. Ensure that this information is accurate as it will be used for verification.
3. Select your type of agency affiliated counselor by marking all applicable options: Employee, Juvenile Probation Counselor, or Student Intern.
4. Indicate whether this is a new application, an update/change, or an additional agency by checking the appropriate box.
5. Fill in the date of hire using the MM/DD/YYYY format to ensure clarity.
6. Provide the agency or facility employer name and physical address, including city, state, and zip code.
7. Confirm that your agency meets the necessary criteria by checking the relevant box regarding its status within Washington State.
8. Finally, have the employer or authorized employee sign and date the form before submission.

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