Instructions
1) Complete the on-line application.
2) Requests for a waiver of any of the Certification Requirements should be noted in the comments section of the application form. Please include a letter to the Certification Committee detailing your request when submitting your application's supporting documentation. All waivers will be evaluated on a case by case basis.
3) Print a copy of the application for your records by using your browser's print button. Please enclose a hard copy of your application with your supporting documentation packet.
4) Submit the on-line application to NBCPC by simply clicking the Submit Application button at the bottom of this page. You will be taken to an order page and then to PayPal's secure website for credit card processing.
5) Within 30 days of your on-line application, mail all required supporting documentation to:
                 NBCPC
                 attn: Certification Committee
                 1331 County Road D
                 St. Paul, MN 55109
6) Pending approval, you will receive your certification in 30 to 45 days.
7) If you have any questions please email comment@nbcpc.org or use the form on the Comments/Questions page.

Certification/Re-Certification Level
 NCPC I
             $ 25 Application Fee 
             $ 130 Certification Fee ($65/year, 2 year certification)
NCPC II
             $ 50 Application Fee
             $ 160 Certification Fee ($80/year, 2 year certification)
NCPC III
             $ 50 Application Fee
             $ 285 Certification Fee ($95/year, 3 year certification)
NCPC Supervisor (must be NCPC II or III)
             $ 25 Application Fee
             $ 105 Certification Fee ($35/year, 3 year certification)

First Name
Last Name
Address
Address
City, State, Zip , ,
Country
Email Address
Day Phone
Evening Phone


Professional Licenses presently held (please mail a certified true copy of all licenses)
License Type License Number Licensing Body Date Expires (mm/yy)
1)
2)
3)
4)

Professional Certifications presently held (please mail a certified true copy of all certifications)
Certification Type Certification Number Certification Body Date Expires (mm/yy)
1)
2)
3)
4)



Current Professional Associations






Degrees held begin with highest degree (please mail a certified true copy of all transcripts)
Degree/Accredidation Date Granted (mm/yy) Institute
1)
2)
3)
4)

Counseling Education
Course name, Semester hours, Institution, Date of completion (mm/yy), Grade (on a 4.0 scale)
1)
2)
3)
4)
5)
6)

Pastoral, Divinity, or Ministry Education
Course name, Semester hours, Institution, Date of completion (mm/yy), Grade (on a 4.0 scale)
1)
2)
3)
4)
5)
6)

Total years of counseling experience
Total hours of supervision received
(Please note: Your supervisor is not required to be a member of NBCPC, but is required to meet the NBCPC supervisor requirements and must send a letter attesting to number of hours of supervision.)


List three professional references
Name, Organization Address, Phone Number
1)
2)
3)

List three references from your church, denomination or fellowship
Name, Organization Address, Phone Number
1)
2)
3)


Have you ever been the subject of disciplinary action by any state, licensing agency, professional board/association or any ethical review committee?
No
Yes - Please provide details in the comments

Are you currently under investigation by any state, licensing agency, professional board/association or any ethical review committee?
No
Yes - Please provide details in the comments

I agree to notify the NBCPC within 30 days of the initiation of any investigation, or disciplinary action, by any state, licensing agency, professional board/association or any ethical review committee.
I agree

I have read, understand, and agree to abide by the NBCPC's Ethical Principles of Pastoral Counselors and Code of Conduct (Code of Ethics).
I agree

I certify that the information presented here is true and complete. I understand that if any information is discovered to be false or misleading, my certification will be immediately suspended or revoked with no refund of any fees.
I agree

Comments



Fees
Application - non refundable
NBCPC I $25
NBCPC II $50
NBCPC III $50
Supervisor $25

Certification - refunded if your application is denied
NBCPC I ($65/yr for 2 yrs) $130
NBCPC II ($80/yr for 2 yrs) $160
NBCPC III ($95/yr for 3 yrs) $285
Supervisor ($35/yr for 3 yrs) $105