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PROFESSIONAL DISCLOSURE STATEMENT
Amy S. Ford, LPC, LHASA
(980× 7221186
Ford. Amy77@yahoo.com
Qualifications
I received my Masters in Professional Counseling from Liberty University in 2010 as well
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How to fill out professional bdisclosureb statement

How to fill out a professional disclosure statement:
01
Start by gathering all relevant information: Before filling out the professional disclosure statement, gather all necessary information such as your contact details, educational background, professional qualifications, licenses, certifications, and any relevant work experience.
02
Understand the purpose of the statement: A professional disclosure statement is typically used to provide important information about yourself and your professional background to clients, employers, or licensing authorities. It helps establish trust, transparency, and credibility in your professional relationships.
03
Begin with personal details: The first section of the disclosure statement usually includes your full name, contact information (phone number, email address), and mailing address. Make sure to provide accurate details that can be easily verified.
04
Provide educational qualifications: Include a section where you mention your educational background. Provide details about the degrees earned, the name of the institutions attended, dates of attendance, and any honors or special achievements.
05
List professional qualifications: In this section, outline any professional qualifications, certifications, or licenses that are relevant to your field. Include the names of the organizations that issued the qualifications, the dates awarded, and any unique identification numbers associated with each qualification.
06
Disclose work experience: Detail your relevant work experience, starting with the most recent one. Include the name of the organization, your job title, a brief description of your responsibilities, and the dates of employment. Additionally, mention any significant achievements or projects you were involved in.
07
Mention any professional affiliations: If you are a member of any professional associations or organizations, include their names and the duration of your membership. This demonstrates your commitment to professional development and staying updated in your field.
08
Provide references: Some professional disclosure statements may require you to provide references who can vouch for your competence and character. Include the names, contact information, and professional relationship of each reference. Make sure to seek consent from the individuals before using their details.
09
Proofread and review: Before submitting your professional disclosure statement, thoroughly proofread it to ensure accuracy and clarity. Double-check your contact details, educational qualifications, and work experience. Make sure the statement is well-organized and free of grammatical or spelling errors.
Who needs a professional disclosure statement?
01
Individuals seeking employment: Job applicants may be required to fill out a professional disclosure statement as part of their application process. This helps employers ensure that the candidate possesses the necessary qualifications and experiences for the role.
02
Independent contractors: Freelancers or independent contractors who provide services to clients may need to prepare a professional disclosure statement. This helps establish trust and transparency with clients, outlining the contractor's professional background and qualifications.
03
Licensed professionals: Licensed professionals in fields such as law, healthcare, or finance usually need to complete a professional disclosure statement. This statement is often required by licensing boards or regulatory authorities to ensure compliance with professional standards and to protect the public's interest.
04
Entrepreneurs and business owners: Entrepreneurs and business owners may use a professional disclosure statement when seeking funding or partnerships. This document provides potential investors or partners with a comprehensive overview of the entrepreneur's background, experience, and qualifications.
Note: The need for a professional disclosure statement may vary depending on industry, jurisdiction, or specific requirements set by employers or licensing authorities. It is important to research and understand the specific regulations or guidelines applicable to your profession.
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What is professional disclosure statement?
A professional disclosure statement is a document that discloses relevant information about a professional's financial interests, potential conflicts of interest, and other important details.
Who is required to file professional disclosure statement?
Professionals such as doctors, lawyers, financial advisors, and others who may have potential conflicts of interest are required to file a professional disclosure statement.
How to fill out professional disclosure statement?
Professionals can typically fill out a professional disclosure statement by providing information about their financial interests, outside business activities, gifts or payments received, and other relevant details.
What is the purpose of professional disclosure statement?
The purpose of a professional disclosure statement is to provide transparency and accountability, as well as to help prevent potential conflicts of interest.
What information must be reported on professional disclosure statement?
Information such as financial interests, outside business activities, gifts or payments received, and any other relevant details that could create a conflict of interest must be reported on a professional disclosure statement.
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