CALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS by 666yj4

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									                       Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                    Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

                    California Certification Board of Chemical Dependency Counselors (CCBCDC)
                               Mailing Address: P.O Box 40043 Downey, CA 90239
                            Telephone. (562) 927-5143     www.californiacertification.org




                                                    STUDENT REGISTRATION APPLICATION

STUDENT REGISTRATIONELIGIBILITY REQUIREMENTS
Individuals who are enrolled at least half-time in a college or university program in accordance to section: § 13040 (a) Requirements for
Initial Certification of AOD Counselors. Must provide verification of active enrollment.

Be sure to include this form with your documents. Use this Documentation Checklist to ensure that you are submitting all the
required documents.

                                                 CCBCDC DOCUMENTATION CHECK LIST

Date: _____________________



    Counselor Name: ________________________________________________                                  SSN: _______________________________

    1.   Signed Application                                                                                     _______ _______
    2.   Copy of Government issued Identification                                                               _______ _______
    3.   Copy of Social Security Card                                                                           _______ _______
    4.   Ethics Certification and Attestation Form                                                              _______ _______
    5.   Certification of Accuracy, Agreement and Release of Authorization                                      _______ _______
    6.   Acknowledgement of Code of Conduct                                                                     _______ _______
    7.   Verification of Student Status/Enrollment documentation                                                _______ _______
    8.   Qualifying Educational Experience Form                                                                 _______ _______
    9.   Verification of Student Status/Enrollment documentation                                                _______ _______
    10. References                                                                                              _______ _______
    11. Application Fees                                                                                        _______ _______
         * Please note, there is a $4.00 processing fee for credit card payments.




  Please keep pages 2, 3 & 10 to 12 for your records.
  Important Notice: All forms must be completed to their entirety to avoid delay in application processing.




CCBCDC Student Registration Application                                                                                                      1
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

                       California Certification Board of Chemical Dependency Counselors (CCBCDC)
                                    Mailing Address: P.O Box 40043 Downey, CA 90239
                                Telephone. (562) 927-5143    www.californiacertification.org


INTRODUCTION
The California Certification Board of Chemical Dependency Counselors (CCBCDC) is an independent not-for profit recognized certifying
board by the State of California Alcohol and Drug Programs Administration (ADP). The mission of our organization is to become the
standard of excellence by which California recognizes certified chemical dependency counselors.
Purpose / Objectives
 To promote positive change in the lives of alcohol and drug dependent people.
 To improve the quality and accountability of the professional counselors.
 To enhance the profession of substance abuse counseling.
Strategies
 Define, promote, and maintain strict, structured, measurable, and fair standards for California substance abuse counselors.
 Create, promote, and maintain a community-based support system for the California substance abuse counseling industry.
 Define, promote, and maintain the highest level of professionalism and ethical standards for California substance abuse counselors.
 Identify and promote continuing improvement of quality in the methodologies used by California substance abuse counselors.
STATE REGULATIONS
The AOD Counselor is the result of the State of California’s regulatory action that adopts Chapter 8 (commencing with Section 13000),
and amends Sections 9846, 10125, and 10564 of Division 4, Title 9 of the California Code of Regulations by establishing requirements for
certification of staff who provide counseling services in alcohol and other drug (AOD) programs.
AOD Counselor Code or Regulations, Section 13005
“Counseling services” means any of the following activities:
(A) Evaluating participants’, patients’, or residents’ AOD treatment or recovery needs, including screening prior to admission, intake, and
assessment of need for services at the time of admission;
(B) Developing and updating of a treatment or recovery plan;
(C) Implementing the treatment or recovery plan;
(D) Continuing assessment and treatment planning;
(E) Conducting individual counseling sessions, group counseling sessions, face-to-face interviews, or counseling for families, couples, and
other individuals significant in the life of the participants, patients, or residents; and
(F) Documenting counseling activities, assessment, treatment and recovery planning, clinical reports related to treatment provided,
progress notes, discharge summaries, and all other client related data.
The certification will establish standards for education, experience, conduct, and complaint investigation for AOD counselors, improving
the quality of the services provided. These regulations are necessary to protect the health, safety, and welfare of AOD participants,
patients, and residents.
AOD COUNSELOR SCOPE OF PRACTICE
Alcohol and other drug counselors work very closely with program participants, patients, and residents, and provide many critical services
including assessments, counseling, treatment planning, and case management. However, counselors are not currently required to be
certified or to have a minimum amount of education or experience. Most treatment programs use or employ a mixture of AOD counselors
who have some formal education or personal experience with alcoholism, drug addiction, and recovery.
ABOUT THE APPLICATION PROCESS
Before you submit your application and documentation, make copies of all of your documents. All materials become the property of the
CCBCDC upon receipt. Copies are not released back to the applicant or third party.
Make sure all documents are completely filled out, and signed and dated where applicable. Ink signatures are required on the application
and all forms. If you make an error, do not use white-out. Mark through the error, write the correction above or beside it, and initial
correction.
It is your responsibility to ensure that the application and all supporting documents have been properly completed and that the information
provided is accurate. Your careful attention will enable prompt and efficient processing. Applicants that are found to have accurate and
untruthful responses may be denied.
When the all Certification Application requirements are met, applicants will be notified by mail about their availability to sit for the CCDC
Examination. Applicants my respond to this notification by submitting a Test Registration Form. our website and faxing or mailing it to
our office including all testing fees payable by credit card, cashiers check or money order.

CCBCDC Student Registration Application                                                                                                    2
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

Applications may not be submitted via fax. Send your application and payment to: The CCBCDC Attn.: Certification/Registration
Department Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143       www.californiacertification.org

STUDENT REGISTRATIONELIGIBILITY REQUIREMENTS
Individuals who are enrolled at least half-time in a college or university program in accordance to section:
§ 13040 (a) Requirements for Initial Certification of AOD Counselors. Must provide verification of active enrollment.

In accordance to: (California Code of Regulations Chapter 8, subchapter 3, Section 13040)
1. Must be over 18 years of age.
2. Provide verification of active enrollment at: Approved Alcohol and Drug Studies Program or show proof of enrollment within
30 days of submitting this application. (Must comply with curriculum specified in TAP 21).
3. Submit signed registration form.
4. Submit signed Code of Ethics.
WHAT HAPPENS TO YOUR APPLICATION AFTER IT REACHES THE CCBCDC
1. When your application arrives at the CCBCDC, your application fee is posted to your account and your application information is
    entered into the CCBCDC’s database.
2. After payment processing, your application is then issued a Registered Intern Number (RIN). RIN numbers are only valid for one
    year.
3.       After the application is reviewed you will be notified of the results in writing. You will also receive a Registered Intern
Verification Document suitable for posting in public view.
4. If you are eligible to sit for the Chemical Dependency Counselor Certification Exam you will be notified in writing. You will also
    receive a registration testing date and a study guide order form.
5. It will take 2 to 8 weeks to receive a reply from the CCBCDC.
Please note that incomplete applications will take longer to process.

The CCBCDC holds incomplete applications open for a two-year period: During that time, every Candidate has the opportunity to
rectify any deficiencies.

LENGTH OF REGISTRATION AND ANNUAL MAINTENANCE FEE
Registration Fee: $20.00 Registration is valid for a period of one year.
Individuals who are enrolled at least half-time in a college or university program in accordance to section:
§ 13040 (a) Requirements for Initial Certification of AOD Counselors. Must provide verification of active enrollment.

If your Credentials have been revoked or suspended, certificates may elect to re-certify by taking and passing the CCDC exam.

CERTIFICATION REQUIREMENTS
Contact the CCBCDC for Certification requirements at: 562-927-5143 or visit our website at www.californiacertification.org.




CCBCDC Student Registration Application                                                                                                    3
                      Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

                       California Certification Board of Chemical Dependency Counselors (CCBCDC)
                                  Mailing Address: P.O Box 40043 Downey, CA 90239
                                Telephone. (562) 927-5143    www.californiacertification.org




                                                             COVER FORM
                                                   STUDENT REGISTRATION APPLICATION

Date:
Initial Registration Application Initial Certification Application Renewal Certification Application 
First Name, Middle Name , Last Name:
Counselor Certification Number (CCDC):                                 Date Issued: _________________________
Date of Birth:____/_____/_____ Marital Status: Single  Married Divorced Separated                                     Widow
Drivers License #_____________________State: ________ Social Security Number: ___________________________
Check Only One: Are you a United States Citizen: Yes                 Are you a United States Resident: Yes 
Have you applied with this board in the past: Yes  No 
Mailing Address (No P.O Boxes):______________________________________________________________________
City:______________________________________________________ State: ________Zip________
Day Telephone Number: ________________________Mobile Telephone Number:_________________________
Evening Telephone Number:_____________________________ Work Telephone Number:_____________________
E-Mail Address:__________________________ Business E-Mail Address: ____________________________
Race as defined by the US Census Bureau (Check One)
American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander 
Asian  White (Non-Hispanic)  Hispanic or Latino  Other  ___________________________________

I have reviewed the minimum requirements for certification and I verify that I am eligible to apply. I understand that practicing within my
scope of training is an ethical responsibility of all processional counselors.


____________________________________                                  ____________________________________
Candidate Signature                                                   Date
*********************************************************************************************************
                                                                CCBCDC USE ONLY
Date Received: ____________ Reviewing Officer: _________________________________

Status: Date Approved _____________Approved: _______                  Date Denied ___________Denied: _______

Pending Additional Information/Verification: _______ Check/Money Order # _____________________________________
*********************************************************************************************************

  All questions on the application package must be acknowledged either by a response or N/A where applicable.



CCBCDC Student Registration Application                                                                                                     4
                      Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

    CCBCDC                                                                      QUALIFYING EDUCATIONAL EXPERIENCE
High School Graduate: Yes _____ No ______ High School Graduation Name: _________________________________________
City: _______________________________________ State _______________________ Year: __________________________
State of California AOD Counselor Education Requirement
Subchapter 3. Requirements for Certification of AOD Counselors, § 13040. Requirements for Initial Certification of AOD Counselors.
Prior to certification as an AOD counselor, the certifying organization shall require each registrant to:
(a) Complete a minimum of 155 documented hours of formal classroom AOD education, which shall include at least the following
subjects: (1) The curriculum contained in the “Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional
Practice”, Technical Assistance Publication Series 21(TAP 21), published by the Substance Abuse and Mental Health Services
Administration, United States Department of Health and Human Services, Printed 2006 Reprinted 2007.
If you are not sure your coursework meets the current educational requirements, you are encouraged to request a pre-review of
coursework. To request a pre-review, send a letter specifying the credential(s) for which you intend to apply along with a legible copy of
all graduate transcripts and the nonrefundable $80.00 fee to:
                                    The California Certification Board of Chemical Dependency Counselors
                                                     Attn: Education Review Department
            Mailing Address:      P.O Box 40043      Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org


This is a pre-review of coursework only and does not guarantee approval to sit for the Chemical Dependency Counselor
Certification Exam. Please allow at least six to eight weeks for a written reply. This pre-review fee cannot be applied to your application
fee. This is not a pre-review for your state credentialing process. Do not apply for certification prior to receiving the results of your pre-
review.
_______________________________________________________________________________________________________________
For education verification please include the following documentation:
A) Official Transcripts from education institution indicating completion of course (Sealed official transcripts must be sent to
CCBCDC address above by the education institution)
B) Copy of award of degree, certificate, diploma, etc.
Post Secondary Institution Name: ______________________________________________________________________________

Address: ____________________________________________________________________________________________________
Year Graduated:_______________________ Area of Education: _______________________________________________________
(Check One) * Type of Degree: ____________ Certificate: _______________ Diploma: __________
Transcript Request Date: ___________ Educational Institution Phone Number: ____________________________


College Name: ______________________________________________________________________________________________

Address: ___________________________________________________________________________________________________
Year Graduated: ________________                 Area of Education:_______________________________________________________
(Check One) * Type of Degree: ____________ Certificate: _______________ Diploma: __________
Transcript Request Date: ___________ Educational Institution Phone Number: ____________________________


University Name: ___________________________________________________________________________________________

Address: __________________________________________________________________________________________________
Year Graduated:________________                  Area of Education:_______________________________________________________
(Check One) * Type of Degree: ____________ Certificate: _______________ Diploma: __________
Transcript Request Date: ___________ Educational Institution Phone Number: ____________________________

  All questions on the application package must be acknowledged either by a response or N/A where applicable.

CCBCDC Student Registration Application                                                                                                        5
                      Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org



                                             ETHICS CERTIFICATION AND ATTESTATION

1. Are you currently a member of a Professional Association or posses Professional Credentials? Yes              No 
   If “yes” please list all professional and occupational licenses, registrations, or other credentials that you hold. Include state,
   agency/board, number, effective date and expiration date.
   _____________________________________________________________________________________________________

2. Has a professional license or certification held by you ever been revoked, suspended, or voluntarily relinquished? Yes  No 
   _____________________________________________________________________________________________________

3. Has a professional credentialing body ever rejected your application because of ethical or legal considerations? Yes  No 
   _____________________________________________________________________________________________________

4. Have you ever been convicted or are you now under charges for any lawsuits, court rulings, statement agreements, or judgments? Yes 
        No 
   _____________________________________________________________________________________________________

5. Have you ever lived outside of the State of California? Yes  No 
   If “yes” please list all states in which you have resided.
  _____________________________________________________________________________________________________

6. Have you ever used any other name other than the one provided in this application? Yes  No 
   If “yes” please list all other names used in the past.
  _____________________________________________________________________________________________________

7. Have you ever been the subject of an investigation by a government agency or other entity? Yes  No 
   If “yes” please list all states in which you have resided.
   _____________________________________________________________________________________________________

Please mark the appropriate box for all questions. If you marked “yes” to any of the above questions please provide a full explanation. Use
additional paper if necessary.

Explanation

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________


We declare under penalty of perjury under the laws of the State of California that the statements above are true and correct.

_____________________________________________________________________
PRINTED NAME OF CANDIDATE


_____________________________________________________________________
SIGNATURE                                                        DATE




CCBCDC Student Registration Application                                                                                                     6
                    Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                 Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org




        CERTIFICATION OF ACCURACY, AGREEMENT AND RELEASE OF AUTHORIZATION

1. By signing this document, I hereby certify that the information provided in this application is true, accurate and compete to
   the best of my knowledge and belief. I understand and agree that the CCBCDC has the right to contact any person,
   government agency, or organization to review or confirm any information provided in this application. I further agree to
   authorize the release of any information requested by the CCBCDC with respect to the review of this application. I further
   understand and agree that the CCBCD has the right to notify pertinent credentialing and professional organizations if it is
   determined that this application contains false information.

2. I understand that if I am granted certification/registration by the CCBCDC and practice counseling, I do so at my own risk.
   I hereby release the CCBCDC from any and all liability and claims that may arise from any and all counseling activity in
   private practice and otherwise.

3. I understand and agree that the CCBCDC registration, certification and re-certification depend upon my fulfillment of all
   required criteria and obligations including compliance with the CCBCDC Code of Ethics. I further agree to fully inform the
   CCBCDC, in a timely manner, if I become the subject of any ethics, disciplinary, criminal, or lesser offenses, complaints or
   charges.

4. I hereby consent to C.C.B.C.D.C. inspection of all record and documents that may be material to an evaluation for the
   certification requested.

5. Upon Registration, Certification or Re-Certification, I understand and agree that the professional biographical data is
   considered to be public information and will be made available in response to consumer/client inquiries. I further agree that,
   for research and statistical purposes only, data resulting from my participation in the CCBCDC credentialing process may
   be used in an anonymous/unidentifiable manner. I understand that all material becomes the property of the CCBCDC upon
   receipt and that neither the originals not photocopies will be returned to me.

6. In the event that my credentials are suspended or revoked, I agree to comply with all directives or orders of the CCBCDC,
   including the return of all CCBCDC credentialing documents. I agree to comply with such directives and orders in a timely
   manner and at my own expense.



_____________________________________________________________________
PRINTED NAME OF CANDIDATE


_____________________________________________________________________
SIGNATURE                                                  DATE

                                     (Duplicate this page before completing)


  All questions on the application package must be acknowledged either by a response or N/A where applicable.




CCBCDC Student Registration Application                                                                                                   7
                       Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                    Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

           CALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS
                                                                        CCBCDC


                                                                 APPLICATION FEES

New Application: ________                         Renewal Application: _______

Last Name:                                                             First Name:
D.O.B:                                                                           S.S.#:
Address:
City:                                                                  State:                          Zip:
Day Phone:                                                             Evening Phone:


Type of Application: (Please check one)

Registration: $20.00 ______
    Individuals who are enrolled at least half-time in a college or university program in accordance to section:
    § 13040 (a) Requirements for Initial Certification of AOD Counselors. Must provide proof of active enrollment.

                                          All fees are non-refundable and non-transferable.

          If you would like to make a payment plan please contact our office to receive payment plan application.

          A $25.00 fee will be charged to all returned checks


    I am attachi

                                   The followoing Amount $________________

    Credit Card Number: ________________________
    Expiration Date: _____________ CV Code: ______
    Name on Credit Card: ____________________________
    Address: ______________________________________


                    California Certification Board of Chemical Dependency Counselors (CCBCDC)
              Mailing Address:     P.O Box 40043      Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org




    Candidate Signature                                                                    Date

  All questions on the application package must be acknowledged either by a response or N/A where
  applicable.




CCBCDC Student Registration Application                                                                                                         8
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

                  California Certification Board of Chemical Dependency Counselors (CCBCDC)
            Mailing Address:     P.O Box 40043      Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org




                                  ACKNOWLEDGEMENT OF COUNSELOR CODE OF CONDUCT


The California Certification Board of Chemical Dependency Counselors (referred to as the Certifying Organization/Board) provides
voluntary certification for Chemical Dependency Counselors in the State of California as a way of assuring professional competence to
clients, to the public, and to employers. The CCBCDC is dedicated to the principle that counselors in the field of alcohol and drug
treatment must confront their behavior to the highest standards of ethical practice. To that end, the CCBCDC. has adopted this Counselor
Code of Conduct to be applied to all pre-certified and Certified Counselors in the state of California.


As a Certified Chemical Dependency Counselors, I agree to follow the Counselor Code of Conduct that is included in my counselor
certification package.

I have read the Counselor Code of Conduct and fully understand all that is contained in it. A copy has been provided to me with the
Counselor Certification application.

I further agree to follow all policies and procedures contained in the Counselor Code of Conduct. I understand my responsibilities as a
chemical dependency counselor.




Counselor Signature                                                  Date




Print Full Name



  All questions on the application package must be acknowledged either by a response or N/A where
  applicable.

Please include this original signed form with your application package
Note: Keep a copy of this form for your records.




CCBCDC Student Registration Application                                                                                                       9
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

                California Certification Board of Chemical Dependency Counselors (CCBCDC)
               Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143
                                         www.californiacertification.org


                                                                 REFERENCES
List references of your choosing who have direct knowledge of your work experience. Please furnish the names, mailing addresses and
telephone numbers of all references provided.
1. Last Name, First Name:________________________________________________________________________________________
Employer: ____________________________________________________________________________________________________
Address:___________________________________________________________City:_________________ State: ________Zip________
Phone Number: _____________In what capacity did you work with this person? __________________ Years ___________




2. Last Name, First Name:________________________________________________________________________________________
Employer: ____________________________________________________________________________________________________
Address:___________________________________________________________City:_________________ State: ________Zip________
Phone Number: _____________In what capacity did you work with this person? __________________ Years ___________




3. Last Name, First Name:________________________________________________________________________
Employer: ____________________________________________________________________________________
Address:______________________________________________________________________________________City:______________
________________________ State: ________Zip________ Phone Number: ___________
In what capacity did you work with this person? ____________________________________ Years ___________




4. Last Name, First Name:________________________________________________________________________________________
Employer: ____________________________________________________________________________________________________
Address:___________________________________________________________City:_________________ State: ________Zip________
Phone Number: _____________In what capacity did you work with this person? __________________ Years ___________




_________________________________________________                              ___________________________
Candidates Position                                                            Name of Agency/Institution

Do not leave any sections blank.




CCBCDC Student Registration Application                                                                                                    10
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

      California Certification Board of Chemical Dependency Counselors (CCBCDC)
                             Mailing Address: P.O Box 40043 Downey, CA 90239
                            Telephone. (562) 927-5143 www.californiacertification.org

                          AOD COUNSELOR CODE OF CONDUCT/ETHICS CODE
____________________________________________________________________
PROFESSIONAL STANDARDS
   1. A counselor shall not fail to meet and comply with all terms, conditions, or limitations of a certification or registration.
   2. Certified Counselors and Registered interns shall maintain a current mailing address and contact telephone number in accordance
       to California Certification Board of Chemical Dependency Counselors guidelines.
   3. A counselor shall not engage in conduct, which does not meet the generally accepted standards of practice of This Chapter of
       Chapter 8 (commencing with Section 13000), and Amendment of Sections 9846, 10125, and 10564, Division 4, Title 9,
       California Code of Regulations.
   4. Registered Interns and Certified Counselors must comply with the Education rules and regulations of this sections 13015, 13020,
       13025, 13030, and 13040.
   5. Advertisements and Directories must be in compliance with: the California Certification Board of Chemical Dependency
       Counselors rules and regulations of this chapter.
   6. A counselor shall not perform services outside of the counselor's area of training, expertise, competence, or scope of practice. In
       accordance to this chapter.
   7. A counselor shall not fail to obtain an appropriate consultation or make an appropriate referral when the client's problem is
       beyond the counselor's area of training, expertise, competence, or scope of practice.
   8. Education: Certified or Registered AOD Counselors must comply with but not limited to the education and continuing education
       rules and regulations of this chapter as set forth by the California Certification Board of Chemical Dependency Counselors.
   9. A Certified Counselor or Registered Intern shall not in any way participate in discrimination on the basis of race, color, sex,
       sexual orientation, age, religion, national origin, socio-economic status, political belief, psychiatric or psychological impairment,
       physical disability, or the amount of previous therapeutic or treatment occurrences.
   10. A counselor shall not refuse to seek therapy for any psychoactive substance abuse or dependence, psychiatric or psychological
       impairment, emotional distress, or for any other physical health related adversity that interferes with the counselor's professional
       functioning, and where any such conditions exist and impede the counselor's ability to function competently, a counselor shall
       request inactive status for medical reasons for so long as is necessary. In accordance to section 4022 of this chapter.
   11. The counselor shall not discontinue professional services to a client/patient nor shall the counselor abandon the client/patient
       without facilitating an appropriate therapeutic closure of professional services for the client/patient. The counselor shall not
       discontinue professional services to a client/patient unless: Services have been completed; The client/patient requests the
       discontinuation; Alternative or replacement services are arranged; or The client/patient is given reasonable opportunity to arrange
       alternative or replacement services.
   12. A counselor shall not reveal confidential information obtained as the result of a professional relationship, without the prior written
       consent from the recipient of services, except as authorized or required by law.
   13. Certified Counselors who are convicted of any felony shall have their certification revoked.\
   14. Counselors charged with a misdemeanor relating to the counselor's ability to practice the substance abuse counseling profession
       shall be grounds for disciplinary action.
   15. A certificate or conviction shall be deemed conclusive evidence of a counselor's guilt of the felony or misdemeanor for which he
       or she has been convicted.
   16. A counselor shall not engage in any form of sexual contact/behavior with clients, nor engage in any form of sexual
       contact/behavior with former therapy clients for two years after the cessation or termination of professional services within the
       client's continuum of care. The prohibition shall apply with respect to any client/patient of the agency by which the counselor is
       employed, regardless of whether or not the client/patient is on the counselor's caseload.
   17. A counselor shall not: Present or cause to be presented a false or fraudulent claim, or any proof in support of such claim, to be
       paid under any contract or certificate of insurance;
   18. Prepare, make or subscribe to a false or fraudulent account, certificate, affidavit, proof of loss or other document or writing, with
       knowledge that the same may be presented or used in support of a claim for payment under a policy of insurance; or
   19. Present or cause to be presented a false or fraudulent claim or benefit application, or any false or fraudulent proof in support of
       such a claim or benefit application, or false or fraudulent information, which would affect a future claim or benefit application, to
       be paid under any employee benefit program.
   20. A counselor shall not use misrepresentation in the preparation of a counselor certification development plan or in the procurement
       of certification or recertification as an alcohol or drug counselor, or assist another in the preparation of a certification
       development plan or in the procurement of registration, certification or re-certification through misrepresentation. The term
       "misrepresentation" includes but is not limited to the misrepresentation of professional qualifications, certification, accreditation,
       affiliations, employment experience, the plagiarism of application and recertification materials, or the falsification of references.

CCBCDC Student Registration Application                                                                                                    11
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

    21. A counselor shall not use a title designation, credential or license, firm name, letterhead, publication, term, title, or document,
        which states or implies an ability, relationship, or qualification that does not exist.
    22. A counselor shall not practice under a false name or under a name other than the name under which his or her certification or
        license is held.
    23. A counselor shall not sign or issue in the counselor's professional capacity a document or a statement that the counselor knows or
        should have known to contain a false or misleading statement.
    24. A counselor shall not produce, publish, create, or partake in the creation of any false, fraudulent, deceptive, or misleading
        advertisement.
    25. A counselor shall not misappropriate property from a client/patient.
    26. A counselor shall not enter into a relationship with a client/patient, which involves financial gain to the counselor or a third party
        resulting from the promotion or the sale of services, unrelated to treatment or of goods, property, or any psychoactive substance.
    27. A counselor shall not promote to a client/patient for the counselor's personal gain any unnecessary, ineffective or unsafe
        psychoactive substance, or any unnecessary, ineffective or unsafe device, treatment, procedure, product or service.
    28. A counselor shall not solicit gifts or favors from clients.
    29. In circumstances where the counselor becomes aware, during the course of providing or supervising professional services, that a
        condition of clear and imminent danger exists that a client/patient may inflict serious bodily harm on another person or persons,
        the counselor shall, consistent with federal and state regulations concerning the confidentiality of alcohol and drug counseling
        records, take reasonable steps to warn any likely victims of the client's behavior.
    30. In circumstances where the counselor becomes aware, during the course of providing or supervising professional services, that a
        condition of clear and imminent danger exists that a client/patient may inflict serious bodily harm to himself or herself, the
        counselor shall, consistent with federal and state regulations concerning the confidentiality of alcohol and drug counseling
        records, take reasonable steps to protect that client/patient.
    31. A counselor shall not administer to himself or herself any psychoactive substance to the extent or in such manner as to be
        dangerous or injurious to a recipient of services, to any other person, or to the extent that such use of any psychoactive substance
        impairs the ability of the counselor to safely and competently provide professional counseling services.
    32. A counselor shall not falsify, amend, knowingly make incorrect entries, or fail to make timely essential entries into the
        client/patient record.
    33. A counselor shall follow all Federal and State regulations regarding client/patient records.
    34. A counselor shall not refer a client/patient to a person that the counselor knows or should know is not qualified by training,
        experience, certification, or license to perform the delegated professional responsibility.
    35. A counselor shall not practice substance abuse counseling during the period of any denial, suspension, revocation, probation, or
        other restriction or discipline on certification, license, or other authorization to practice issued by any certification authority or
        any state, province, territory, tribe, or the federal government.
    36. A counselor shall cooperate in any investigation conducted pursuant to this Code of Conduct and a counselor shall not interfere
        with an investigation or a disciplinary proceeding or attempt to prevent a disciplinary proceeding or other legal action from being
        filed, prosecuted, or completed. Interference attempts may include but are not limited to: The willful misrepresentation of facts
        before the disciplining authority or its authorized representative;
             a) The use of threats or harassment against, or an inducement to, any client/patient or witness in an effort to prevent them
                  from providing evidence in a disciplinary proceeding or any other legal action;
             b) The use of threats or harassment against, or an inducement to, any person in an effort to prevent or attempt to prevent a
                  disciplinary proceeding or other legal action from being filed, prosecuted or completed.
    37. A counselor shall report any violation of the Counselor Code of Conduct. Failure to report a violation may be grounds for
        discipline.
    38. A counselor who has firsthand knowledge of the actions of a respondent counselor or a complainant shall cooperate with a the
        California Certification Board of Chemical Dependency Counselors complaint investigation or disciplinary proceeding. Failure or
        an unwillingness to cooperate with the California Certification Board of Chemical Dependency Counselors complaint
        investigation or disciplinary proceeding shall be grounds for disciplinary action.
    39. A counselor shall not file a complaint or provide information to the California Certification Board of Chemical Dependency
        Counselors, which the counselor knows or should have known, is false or misleading.
    40. In submitting any information to the Certification Organization, a counselor shall comply with any requirements pertaining to the
        disclosure of client/patient information established by the federal or state government.
    41. Violent And Serious Felonies Pursuant To Penal Codes 667.5(C) And 1192.7(C).
             Enhancement of prison terms for new offenses because of prior prison terms shall be imposed as follows:
               (a) Where one of the new offenses is one of the violent felonies specified in subdivision (c), in addition to and consecutive
             to any other prison terms therefore, the court shall impose a three-year term for each prior separate prison term served by the
             defendant where the prior offense was one of the violent felonies specified in subdivision (c). However, no additional term
             shall be imposed under this subdivision for any prison term served prior to a period of 10 years in which the defendant
             remained free of both prison custody and the commission of an offense which results in a felony conviction.

CCBCDC Student Registration Application                                                                                                    12
                    Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                 Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

              (b) Except where subdivision (a) applies, where the new offense is any felony for which a prison sentence is imposed, in
            addition and consecutive to any other prison terms therefore, the court shall impose a one-year term for each prior separate
            prison term served for any felony; provided that no additional term shall be imposed under this subdivision for any prison
            term served prior to a period of five years in which the defendant remained free of both prison custody and the commission of
            an offense which results in a felony conviction.
              (c) For the purpose of this section, "violent felony" shall mean any of the following:
              (1) Murder or voluntary manslaughter.
              (2) Mayhem.
              (3) Rape as defined in paragraph (2) or (6) of subdivision (a) of Section 261 or paragraph (1) or (4) of subdivision (a) of
            Section 262.
              (4) Sodomy by force, violence, duress, menace, or fear of
            immediate and unlawful bodily injury on the victim or another person.
              (5) Oral copulation by force, violence, duress, menace, or fear of immediate and unlawful bodily injury on the victim or
            another person.
              (6) Lewd acts on a child under the age of 14 years as defined in Section 288.
              (7) Any felony punishable by death or imprisonment in the state prison for life.
              (8) Any felony in which the defendant inflicts great bodily injury on any person other than an accomplice which has been
            charged and proved as provided for in Section 12022.7 or 12022.9 on or after July 1, 1977, or as specified prior to July 1,
            1977, in Sections 213, 264, and 461, or any felony in which the defendant uses a firearm which use has been charged and
            proved as provided in Section 12022.5 or 12022.55.
              (9) Any robbery.
              (10) Arson, in violation of subdivision (a) or (b) of Section 451.
              (11) The offense defined in subdivision (a) of Section 289 where the act is accomplished against the victim's will by force,
            violence, duress, menace, or fear of immediate and unlawful bodily injury on the victim or another person.
              (12) Attempted murder.
              (13) A violation of Section 12308, 12309, or 12310.
              (14) Kidnapping.
              (15) Assault with the intent to commit mayhem, rape, sodomy, or oral copulation, in violation of Section 220.
              (16) Continuous sexual abuse of a child, in violation of Section 288.5.
              (17) Carjacking, as defined in subdivision (a) of Section 215.
              (18) A violation of Section 264.1.
              (19) Extortion, as defined in Section 518, which would constitute a felony violation of Section 186.22 of the Penal Code.
              (20) Threats to victims or witnesses, as defined in Section 136.1, which would constitute a felony violation of Section
            186.22 of the Penal Code.
              (21) Any burglary of the first degree, as defined in subdivision (a) of Section 460, wherein it is charged and proved that
            another person, other than an accomplice, was present in the residence during the commission of the burglary.
              (22) Any violation of Section 12022.53.
              (23) A violation of subdivision (b) or (c) of Section 11418.
              The Legislature finds and declares that these specified crimes merit special consideration when imposing a sentence to
            display society's condemnation for these extraordinary crimes of violence against the person.

              (d) For the purposes of this section, the defendant shall be deemed to remain in prison custody for an offense until the
            official discharge from custody or until release on parole, whichever first occurs, including any time during which the
            defendant remains subject to re-imprisonment for escape from custody or is re-imprisoned on revocation of parole. The
            additional penalties provided for prior prison terms shall not be imposed unless they are charged and admitted or found true
            in the action for the new offense.
            (e) The additional penalties provided for prior prison terms shall not be imposed for any felony for which the defendant did
            not serve a prior separate term in state prison.
            (f) A prior conviction of a felony shall include a conviction in another jurisdiction for an offense which, if committed in
            California, is punishable by imprisonment in the state prison if the defendant served one year or more in prison for the
            offense in the other jurisdiction. A prior conviction of a particular felony shall include a conviction in another jurisdiction for
            an offense which includes all of the elements of the particular felony as defined under California law if the defendant served
            one year or more in prison for the offense in the other jurisdiction.
            (g) A prior separate prison term for the purposes of this section shall mean a continuous completed period of prison
            incarceration imposed for the particular offense alone or in combination with concurrent or consecutive sentences for other
            crimes, including any re-imprisonment on revocation of parole which is not accompanied by a new commitment to prison,
            and including any re-imprisonment after an escape from incarceration.


CCBCDC Student Registration Application                                                                                                     13
                    Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                 Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

              (h) Serving a prison term includes any confinement time in any state prison or federal penal institution as punishment for
            commission of an offense, including confinement in a hospital or other institution or facility credited as service of prison time
            in the jurisdiction of the confinement.
              (i) For the purposes of this section, a commitment to the State Department of Mental Health as a mentally disordered sex
            offender following a conviction of a felony, which commitment exceeds one year in duration, shall be deemed a prior prison
            term.
              (j) For the purposes of this section, when a person subject to the custody, control, and discipline of the Director of
            Corrections is incarcerated at a facility operated by the Department of the Youth Authority, that incarceration shall be
            deemed to be a term served in state prison.
              (k) Notwithstanding subdivisions (d) and (g) or any other provision of law, where one of the new offenses is committed
            while the defendant is temporarily removed from prison pursuant to Section 2690 or while the defendant is transferred to a
            community facility pursuant to Section 3416, 6253, or 6263, or while the defendant is on furlough pursuant to Section 6254,
            the defendant shall be subject to the full enhancements provided for in this section.
              This subdivision shall not apply when a full, separate, and consecutive term is imposed pursuant to any other provision of
            law.
            1192.7. (a) Plea bargaining in any case in which the indictment or information charges any serious felony, any felony in
            which it is alleged that a firearm was personally used by the defendant, or any offense of driving while under the influence of
            alcohol, drugs, narcotics, or any other intoxicating substance, or any combination thereof, is prohibited, unless there is
            insufficient evidence to prove the people's case, or testimony of a material witness cannot be substantial change in sentence.
              (b) As used in this section "plea bargaining" means any bargaining, negotiation, or discussion between a criminal
            defendant, or his or her counsel, and a prosecuting attorney or judge, whereby the defendant agrees to plead guilty or nolo
            contendere, in exchange for any promises, commitments, concessions, assurances, or consideration by the prosecuting
            attorney or judge relating to any charge against the defendant or to the sentencing of the defendant.
              (c) As used in this section, "serious felony" means any of the following:
              (1) Murder or voluntary manslaughter; (2) mayhem; (3) rape; (4) sodomy by force, violence, duress, menace, threat of great
            bodily injury, or fear of immediate and unlawful bodily injury on the victim or another person; (5) oral copulation by force,
            violence, duress, menace, threat of great bodily injury, or fear of immediate and unlawful bodily injury on the victim or
            another person; (6) lewd or lascivious act on a child under the age of 14 years; (7) any felony punishable by death or
            imprisonment in the state prison for life; (8) any felony in which the defendant personally inflicts great bodily injury on any
            person, other than an accomplice, or any felony in which the defendant personally uses a firearm; (9) attempted murder; (10)
            assault with intent to commit rape or robbery; (11) assault with a deadly weapon or instrument on a peace officer; (12) assault
            by a life prisoner on a non-inmate; (13) assault with a deadly weapon by an inmate; (14) arson; (15) exploding a destructive
            device or any explosive with intent to injure; (16) exploding a destructive device or any explosive causing bodily injury, great
            bodily injury, or mayhem; (17) exploding a destructive device or any explosive with intent to murder; (18) any burglary of
            the first degree; (19) robbery or bank robbery; (20) kidnapping; (21) holding of a hostage by a person confined in a state
            prison; (22) attempt to commit a felony punishable by death or imprisonment in the state prison for life; (23) any felony in
            which the defendant personally used a dangerous or deadly weapon; (24) selling, furnishing, administering, giving, or
            offering to sell, furnish, administer, or give to a minor any heroin, cocaine, phencyclidine (PCP), or any methamphetamine-
            related drug, as described in paragraph (2) of subdivision (d) of Section 11055 of the Health and Safety Code, or any of the
            precursors of methamphetamines, as described in subparagraph (A) of paragraph (1) of subdivision (f) of Section 11055 or
            subdivision (a) of Section 11100 of the Health and Safety Code; (25) any violation of subdivision (a) of Section 289 where
            the act is accomplished against the victim's will by force, violence, duress, menace, or fear of immediate and unlawful bodily
            injury on the victim or another person; (26) grand theft involving a firearm; (27) carjacking; (28) any felony offense, which
            would also constitute a felony violation of Section 186.22; (29) assault with the intent to commit mayhem, rape, sodomy, or
            oral copulation, in violation of Section 220; (30) throwing acid or flammable substances, in violation of Section 244; (31)
            assault with a deadly weapon, firearm, machinegun, assault weapon, or semiautomatic firearm or assault on a peace officer or
            firefighter, in violation of Section 245; (32) assault with a deadly weapon against a public transit employee, custodial officer,
            or school employee, in violation of Sections 245.2, 245.3, or 245.5; (33) discharge of a firearm at an inhabited dwelling,
            vehicle, or aircraft, in violation of Section 246; (34) commission of rape or sexual penetration in concert with another person,
            in violation of Section 264.1; (35) continuous sexual abuse of a child, in violation of Section 288.5; (36) shooting from a
            vehicle, in violation of subdivision (c) or (d) of Section 12034; (37) intimidation of victims or witnesses, in violation of
            Section 136.1; (38) criminal threats, in violation of Section 422; (39) any attempt to commit a crime listed in this subdivision
            other than an assault; (40) any violation of Section 12022.53; (41) a violation of subdivision (b) or (c) of Section 11418; and
            (42) any conspiracy to commit an offense described in this subdivision.

              (d) As used in this section, "bank robbery" means to take or attempt to take, by force or violence, or by intimidation from
            the person or presence of another any property or money or any other thing of value belonging to, or in the care, custody,
            control, management, or possession of, any bank, credit union, or any savings and loan association.
              As used in this subdivision, the following terms have the following meanings:
CCBCDC Student Registration Application                                                                                                     14
                     Student Registration Application: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143              www.californiacertification.org

                (1) "Bank" means any member of the Federal Reserve System, and any bank, banking association, trust company, savings
             bank, or other banking institution organized or operating under the laws of the United States, and any bank the deposits of
             which are insured by the Federal Deposit Insurance Corporation.
                (2) "Savings and loan association" means any federal savings and loan association and any "insured institution" as defined
             in Section 401 of the National Housing Act, as amended, and any federal credit union as defined in Section 2 of the Federal
             Credit Union Act.
                (3) "Credit union" means any federal credit union and any state-chartered credit union the accounts of which are insured by
             the Administrator of the National Credit Union administration.
             (e) The provisions of this section shall not be amended by the Legislature except by statute passed in each house by roll call
             vote entered in the journal, two-thirds of the membership concurring, or by a statute that becomes effective only when
             approved by the electors.
         42. Disciplinary sanctions to issued by another state or governmental licensing and certification agency.
         43. A person held in custody, captivity, or a condition of forcible restraint, especially while on trial or serving a prison sentence
             may not apply to the CCBCDC for registration or certification.
         44. Engaging in unprofessional conduct, including but not limited to (a) any practice that creates unnecessary danger to a client's
             life, health or safety; and (b) any practice that is contrary to the ethical conduct in accordance to the CCBCDC Code of Ethics
             that results in termination or suspension from practice.
         45. A Counselors/Registered intern shall not physically, verbally threaten, harass or abuse any patient/client, co-worker,
             administrators, or CCBCDC employees, volunteers, board members, committee members.


         DISCIPLINARY PROCEDURES/CONFIDENTIALITY of PROCEEDINGS
         Except as is otherwise provided herein, all information received and all reports, decisions files, transcripts or any other
         documents, of any kind, generated or received during the course of a disciplinary proceeding shall be kept confidential by the
         California Certification Board of Chemical Dependency Counselors and the respondent.

         * Amended 09/28/2009 to Reflect the new CCBCDC mailing address.

COMPLAINTS
Persons wishing to file a complaint against a certified counselor or against a person under the California Certification Board of Chemical
Dependency Counselors jurisdiction seeking certification may do so by obtaining and filling out a formal complaint form. Complaint
forms may be obtained from the California Certification Board of Chemical Dependency Counselors office.

All complaint forms must contain the complainant's address and a phone number where the complainant can be contacted. The
complainant must sign and date the complaint form. Mail complaint forms to the following address:

                                     California Certification Board of Chemical Dependency Counselors
                                                        Attn.: Complaints Department
                                            Mailing Address: P.O Box 40043 Downey, CA 90239
                                           Telephone. (562) 927-5143 www.californiacertification.org




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