A. Required
Application Materials
An individual applying for licensure as a Mental
Health/Mental Retardation Administrator shall submit to the Division the
following:
(1) A completed, notarized
Application Form;
(2) A completed
Verification of Employment Form;
(3) Official transcript(s) from an approved
educational institution(s) reflecting a master's degree (at least a 30 semester
hour program) in Mental Health, Mental Retardation, Alcohol and Substance
Abuse, Business Administration, Accounting, Public Policy Administration or a
related field;
(4) A completed
Verification of Experience Form(s) reflecting at least four (4) years of
supervised experience in the field of mental health and / or mental
retardation, two (2) of which must be in the State of Mississippi and two (2)
of which must have been administrative experience;
(5) At least three letters of support which
meet the specifications indicated in Chapter 3, Section 3, A., (5), p. 7;
and,
(6) A non-refundable $75.00
Application Fee made payable to the Mississippi Department of Mental Health.
Note: This fee includes administrative costs incurred by the
Division over the approximate two years it would take a Participant to complete
the program of Independent Study and Training, the remainder of the first
two-year licensure period once licensure has been attained and the cost of the
certificate.
B.
Submission of Application Packet
(1) Items
1-6, indicated in Chapter 4, Section 2, A., pp. 16-17, should be completed by
the appropriate person(s) indicated on the form(s), collected by the Applicant
and submitted together in one application packet to the Division.
(2) Items 2-5, indicated in Chapter 4,
Section 2, A., pp. 16-17, should be sent in sealed envelopes with a signature
across the seal that matches the signature on the document inside the envelope.
Signatures on the envelopes and forms will be verified by the Division. Item 3,
the official transcript, must be submitted in the envelope provided by the
approved educational institution when given to the Applicant.
(3) If necessary, the official transcript
(Item 3) may be submitted to the Division directly by the approved educational
institution.
(4) An individual may
apply for more than one DMH professional certification/licensure (MH/MR
Administrator, Mental Retardation Therapist, Mental Health Therapist, etc.);
however, each application packet should be submitted separately, including
separate official transcripts, application forms, payment of application fees,
etc.
C. Responsibility
for Application
(1) The responsibility for
submitting a complete application is that of the Applicant.
(2) The Review Board will not review
incomplete applications. See Chapter 2, Section 2, B., (4), p. 4.
