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Request for Statement of Qualifications and Applications for Licensed Therapists to Provide Shorter Counseling Services EXHIBIT B PART 1 APPLICATION & THERAPIST QUESTIONNAIRE Applicants are required

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Obtain the necessary form for requesting a statement of

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Fill out your personal information such as name, address, and contact details

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Individuals who require a formal document or record of their personal information or statement

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What is request for statement of?

Request for statement of is a formal document used to ask for a written statement of information or details.

Who is required to file request for statement of?

Anyone seeking specific information or details is required to file a request for statement of.

How to fill out request for statement of?

You can fill out a request for statement of by providing all necessary information and details in the designated sections of the form.

What is the purpose of request for statement of?

The purpose of a request for statement of is to obtain a written statement of information or details on a particular subject.

What information must be reported on request for statement of?

The information that must be reported on a request for statement of includes the specific details or information being requested.

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