License Renewal Application

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Current License #(Required)

Please make sure to enter your 4 Digit License number.

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LCAC and LMAC applicants: The requirement is three hours of clinical supervision continuing education per two-year cycle. The deadline to submit the three hours is December 1, 2021. These hours are included in the 40 hours needed for licensure renewal.

Have you completed the above requirement?(Required)

Yes

No

LACs applicants:LACs are able to maintain clinical supervision privileges through December 31, 2023.

North Dakota Administrative Code Chapter 4.5-02.1-02-02. Continuing education.

Continuing education credit is awarded to a participant at a workshop or seminar. To maintain licensure, licensed addiction counselors, licensed clinical addiction counselors, and licensed master addiction counselors are required to complete forty hours of continuing education for the two-year licensing period, at least six hours of which must be on the topic of professional ethics.

Twenty approved continuing education hours are required if an addiction counselor is initially licensed between January first and June thirtieth of the odd-numbered year.
No continuing education hours are required if an addiction counselor is initially licensed on or after July first of an odd-numbered year.
Continuing education hours cannot be earned until after the license effective date and only within the current licensing period.
Continuing education hours may only be applied to one licensing period.

All licensees are responsible for tracking own continuing education record. As required under North Dakota Administrative Rules 4.5-02.1-02-02, sections 4-7:

At the end of the two-year reporting cycle, each licensee or registrant shall submit a signed statement on a form provided by the board attesting to satisfaction of the continuing education requirement. The licensee or registrant shall list the activities submitted for continuing education credit and the amount of credit claimed for each one and the date for each session.
The licensee or registrant may not submit the specific verification of each continuing education experience claimed, but must maintain a file of such verification documentation for two years following the submission of the reporting form.
At each reporting period, the board will select a random sample of approximately ten percent of the licensees and require them to provide verification of the continuing education experiences claimed on the reporting form.
Any licensed addiction counselor, licensed clinical addiction counselor, or licensed master addiction counselor who is registered as a clinical supervisor shall ensure at least three of the forty continuing education hours contain materials related to clinical supervision techniques and skills, with documentation verifying the content submitted to the board upon request.

I have completed or will have completed the forty (40) hours of continuing education, including six (6) hours of professional ethics, as required by N.D.C.C. § 43-45-04 and N.D. Administrative Code 4.5-02.1-02-02 during the licensure period. If the NDBACE concludes that I have not complied with the requirements set forth in NDCC § 43-45-04 and N.D. Administrative Code 4.5-02.1-02-02, and the NDBACE does not grant an extension or waiver if an extension or waiver is allowable under the law, I hereby agree to waive my right to an administrative hearing and appeal pursuant to NDCC ch. 28-32, and agree that the NDBACE may issue an order taking disciplinary action against my license.

Checking this box is equivalent to a signature, confirming you have read and confirm the above statements.(Required)

I have read and confirm the statements above.

I have read and understand the NDBACE Code of Ethics and agree to adhere to the Code.(Required)

Yes

No

In the last two years, have you been convicted of an offense other than a minor traffic violation?(Required)

Yes

No

Written explanation including the nature of the offense and action taken.(Required)

In the last two years, have you experienced any impairments that affect your ability to follow the standards of NAADAC Code of Ethics?(Required)

The cod of ethics can be found here: https://www.naadac.org/assets/2416/naadac-nccap-code-of-ethics11-04-16.pdf

Yes

No

Written Explanation(Required)

In the last two years, have you been sanctioned or disciplined by a state licensing or credentialing agency?(Required)

Yes

No

Written Explanation(Required)

I certify that I am the person who is referred to in the foregoing application in the State of North Dakota, that the statements contained herein are strictly true in every respect, and that I have read and understand this affidavit.

Personal information” contained on this application is an “exempt record”. NDCC 44-04-18.1. An “exempt record”is a record that may be released to the public at the discretion of the public entity. NDCC 44-04-17.1(5). “Personal information” includes a person's home address; home telephone number or personal cell phone number; photograph; medical information; motor vehicle operator's identification number; public employee identification number; payroll deduction information; the name, address, telephone number, and date of birth of any dependent or emergency contact; any credit, debit, or electronic fund transfer card number; and any account number at a bank or other financial institution. NDCC 44-04-18.1(2).

Checking this box is equivalent to a signature, confirming you have read and confirm the above statements.(Required)

I have read and confirm the statements above.

Your license will expire if the renewal process is not completed by December 31, 2021. It is illegal to practice addiction counseling without a current license.

A late fee of $200 will be charged if not submitted by December 1, 2021.

Will you be paying your renewal fee by Check or PayPal / Credit Card(Required)

Check

PayPal / Check (Fees Apply)

Be sure to pay the $300 application fee to complete your renewal process. Online payment can be taken through PayPal, accessed through our website.
Check or money order can be mailed to the address below:
NDBACE
1601 N 12th Street, Suite 609
Bismarck ND 58501

Please click "Submit" to complete your application.

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License Renewal Application

License Renewal Application (2023)