LETTER OF RECOMMENDATION
TO
Arkansas Board of Examiners in Counseling
The applicant must complete items 1-3. Item 4 is optional. Address is required for
return of recommendation directly to the applicant in sealed & signed envelope.
1. Applicant’s Name (Print):______________________________________________
2. Applicant’s Address: __________________________________________________
3. Proposed Area(s) of Counseling Practice: LAC ___ LPC___ LAMFT ___
LMFT ____Dual LAC/LAMFT____ Dual LPC/LMFT____
4. I waive the right by the Family Education Rights and Privacy Act of 1974
(Buckley Amendment) to view this letter of recommendation on file with Board.
Signature:
Forward this form to an individual well acquainted with your education and
counseling.
To Writer of Letter of Recommendation:
Length of time you have know applicant: Dates from: ___________ to ___________
Please rate the applicant in the following categories:
No Opinion 1=Poor 2=Fair 3=Good 4=Very Good 5=Excellent
Professional Ethics: _______________________________________________________
_______________________________________________________________________
Professional Knowledge: ___________________________________________________
_______________________________________________________________________
Personal Character: _______________________________________________________
_______________________________________________________________________
Professional Training: _____________________________________________________
_______________________________________________________________________
Counseling Skill Application: _______________________________________________
________________________________________________________________________
Please comment in detail regarding the applicant and the basis for your judgment in
rating the applicant on the space below: (add additional pages if desired)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Print Name: _________________________________ Date: ______________________
Signature: __________________________________ Title: ______________________
Institution Name: ____________________________ Address: ___________________
Phone Number: ______________________________ Fax Number: _______________
Do you hold a license or certificate to practice as a:
• Counselor ___________ • Therapist ____________ • Psychologist ___________
• Other ______ (Specify) _________________________ • N/A __________________
Return this form directly to: Applicant’s Address listed above (seal and
signature across the sealed envelope. Candidates must collect all four
references and then send all to the board office.
