[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-330393-105":59,"doc-detail-330393-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","491-licensure-by-endorsement","491 - Licensure by Endorsement","","Application packet for licensure by endorsement issued by the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling. It explains eligibility for active licensees in another state and outlines fee structure, payment and refund rules. The form requests personal information, equal opportunity data, email notification consent, and disclosures related to public records and Social Security number collection. It also includes applicant background questions, such as prior names and professional licensing history.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/491-licensure-by-endorsement/330393/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/491-licensure-by-endorsement/330393.png","ImageObject",300,407,{"name":92,"@type":93},"Evangeline","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who is eligible to apply for licensure by endorsement?","Question",{"text":112,"@type":113},"Applicants must hold a valid, current license in another state in the specific profession and have actively practiced in that profession for at least three of the past five years.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What are the total application fees and what do they include?",{"text":117,"@type":113},"The total fee is $180.00. It includes an application fee of $100.00, an initial licensure fee of $75.00, and an unlicensed activity fee of $5.00.",{"name":119,"@type":110,"acceptedAnswer":120},"How are refund requests handled if an application is denied or withdrawn?",{"text":121,"@type":113},"If denied or withdrawn, applicants are entitled to an $80.00 refund (initial licensure fee and unlicensed activity fee). Requests to withdraw or for a refund must be made in writing, and fees are refundable up to three years from the date of receipt.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},330393,1790372754,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41},13056703019662,"https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188","Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling  \nP.O. Box 6330  \nTallahassee, FL 32314-6330  \n[Website: www.floridasmentalhealthprofessions.gov](Website: www.floridasmentalhealthprofessions.gov)  \n[Email: MQA.491@flhealth.gov](Email: MQA.491@flhealth.gov)[ ](Email: MQA.491@flhealth.gov)[Phone:](Phone:) (850) 245-4292  \nFAX: (850) 413-6982  \nHEALTH  \nMedical QualiAssurancety  \nAre you an active-duty member of the United States Armed Services?  \nAre you a veteran of the United States Armed Services? Are you the spouse of a veteran of the United States Armed Services? Are you the spouse of an active member of the United States Armed Services?  \nIf you answered “Yes” to any of these questions, you may qualify for a reduction in your application fees. You can find information about the Florida Department of Health’s commitment to serving members and veterans of the United States Armed  \nForces and their families online at [http://www.flhealthsource.gov/valor](http://www.flhealthsource.gov/valor).  \nApplication for Licensure as a Clinical Social Worker, Marriage & Family Therapist or Mental Health Counselor by Endorsement  \nBoard of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling  \nP.O. Box 6330  \nTallahassee, FL 32314-6330  \nFax: (850) 413-6982  \n[Email: MQA.491@flhealth.gov](Email: MQA.491@flhealth.gov)  \nDo Not Write in this Space For Revenue Receipting Only  \nApplicants must hold a valid, current license in another state in the specific profession identified for licensure and have actively practiced in that profession for at least three of the past five years. If you do not meet both the licensure and practice requirements you are ineligible to apply by endorsement and must apply by examination.  \n\n| Select profession:\u003Cbr>Clinical Social Work (5201) Marriage & Family Therapy (5202) Mental Health Counseling (5203) | $180.00\u003Cbr>$180.00\u003Cbr>$180.00 | Total fee of $180.00 includes the following:\u003Cbr>Application Fee $100.00\u003Cbr>Initial Licensure Fee $75.00\u003Cbr>Unlicensed Activity Fee $5.00 |\n| --- | --- | --- |\n| Fees must be paid in the form of a cashier’s check or money order, made payable to the Department of Health. An applicant who is denied licensure or withdraws their application is entitled to an $80.00 (Initial Licensure Fee and Unlicensed Activity Fee) refund. Requests to withdraw or for a refund must be made in writing. Fees are refundable for up to three years from the date of receipt. |  |  |\n\n1. PERSONAL INFORMATION  \n\n| Name:   Date of Birth:  \u003Cbr>Last/Surname First Middle MM/DD/YYYY\u003Cbr>Mailing Address: (The address where mail and your license should be sent)\u003Cbr>Street/P.O. Box Apt. No. City State ZIP Country Home/Cell Telephone\u003Cbr>Practice Location: (Required if mailing address is a P.O. Box-This address will be posted on the Department of Health’s website. ) Street Suite No. City\u003Cbr>State ZIP Country Work/Cell Telephone\u003Cbr>EQUAL OPPORTUNITY DATA:\u003Cbr>We are required to ask that you furnish the following information as part of your voluntary compliance with 41 CFR Part 60-3-Uniform Guidelines on Employee Selection Procedure (1978); 43 FR 38295 and 38296 (August 25, 1978) . This information is gathered for statistical and reporting purposes only and does not in any way affect your candidacy for licensure.\u003Cbr>Gender: Male Race: Native Hawaiian or Pacific Islander Hispanic or Latino White\u003Cbr>Female American Indian or Alaska Native Black or African American Asian\u003Cbr>Two or More Races |\n| --- |\n| Email Notification: To be notified of the status of your application by email, check the “Yes”box and fill in your email address on the line provided. If you choose to be notified via email you will be responsible for checking your email regularly and updating your email address with the board office.\u003Cbr>Yes No Email Address:  \u003Cbr>Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records ","cbCaioBFcsaugire","https://ap.wps.com/l/cbCaioBFcsaugire","pdf",2994236,12,"English","# Personal Information\n## Equal Opportunity Data\n## Email Notification\n# Social Security Disclosure\n# Applicant Background","[{\"question\":\"Who is eligible to apply for licensure by endorsement?\",\"answer\":\"Applicants must hold a valid, current license in another state in the specific profession and have actively practiced in that profession for at least three of the past five years.\"},{\"question\":\"What are the total application fees and what do they include?\",\"answer\":\"The total fee is $180.00. It includes an application fee of $100.00, an initial licensure fee of $75.00, and an unlicensed activity fee of $5.00.\"},{\"question\":\"How are refund requests handled if an application is denied or withdrawn?\",\"answer\":\"If denied or withdrawn, applicants are entitled to an $80.00 refund (initial licensure fee and unlicensed activity fee). Requests to withdraw or for a refund must be made in writing, and fees are refundable up to three years from the date of receipt.\"}]","491 - Licensure by Endorsement | PDF",1789988609]