24 Miss. Code. R. 3-11.2 - LA (Licensure) Application Packet

A. Once a "Program Participant" has completed the Independent Study and Training requirement, the individual should apply for licensure as a DMH Licensed Administrator (LA), by submitting an application packet which contains the following:

1. LA Application Form (which includes sponsorship designation);

2. LA Verification of Employment Form;

3. Independent Study and Training Requirement Documentation:

a. If the applicant completed Independent Study and Training Requirement Option One:

i. Copy of CPM Certificate; and,

ii. Copy of Focus Certificate.

b. If the applicant completed Independent Study and Training Requirement Option Two:

i. Copy of CPM Certificate

ii. The Division maintains a copy of DMH Licensed Administrator Program Examination completion records; the applicant does not have to submit a copy of this information.

B. If the LA applicant is applying directly for licensure (i.e., completely bypassing the Program Participant phase), the following additional LA application component(s) are also required:

1. Official Transcript;

2. LA Verification of Work Experience Form;

3. Three Letters of Support; and,

4. Application Fee - $75.00 fee (submitted in a manner prescribed by the Mississippi Department of Mental Health). (If progressing from LA Program Participant to LA licensure, no additional application fee is required.) Only individuals applying directly for licensure pay the application fee. This is a ONE TIME fee; applicants should not pay the application fee twice.

C. Application Forms are located online at the agency (DMH) website, as an addendum to this document. Individuals needing a print copy should contact the Division.

Notes

24 Miss. Code. R. 3-11.2

Section 41-4-7 of the Mississippi Code of 1972, Annotated

Adopted 5/1/2017