Doh wa AgencyAffiliatedCounselorAgency Affiliated Counselor :: Washington State Department of 2026

1. Click ‘Get Form’ to open the Agency Affiliated Counselor Employment/Student Verification Form in the editor.
2. Begin by filling in your name and credential number in the designated fields at the top of the form. Ensure that this information is accurate and clearly printed.
3. Next, indicate your type of agency affiliated counselor by marking all applicable options: Employee, Juvenile Probation Counselor, or Student Intern.
4. Select one option regarding your agency status: New Agency, Update/Change Agency, or Additional Agency.
5. Provide the agency or facility employer name and physical address. Make sure to include city, state, and zip code for clarity.
6. Confirm that your agency meets the necessary criteria as outlined in WAC 246-810-016 and WAC 246-810-015 by checking the appropriate box.
7. Finally, have an authorized employee sign and date the form before submitting it to the provided address.

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