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Indiana Professional Licensing Agency

PLA > Professions > Genetic Counselors > Licensure Application Licensure Application

Application Form

Out of State Verification Form

Criminal Background Check Information

Frequently Asked Questions

 

GENETIC COUNSELOR LICENSURE INFORMATION & INSTRUCTIONS

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE COMPLETING AND SUBMITTING YOUR APPLICATION.  If after reading the instructions you have questions please contact our office.

CONTACT INFORMATION
Indiana Professional Licensing Agency
Medical Licensing Board
402 W. Washington Street, Room W072
Indianapolis, IN 46204
Email:  pla3@pla.IN.gov
(317) 234-2060
(317) 233-4236 (fax)

PROCESSING TIME

Processing time depends on the applicant.  The applicant is responsible for the submission of all documents.  The sooner the documents are requested and received the quicker the license can be issued.  Once complete, it will be issued within 5-7 working days.  If you have a positive response, the license/temporary cannot be issued until it has been reviewed by the Board.  The Board meets on a monthly basis.

FAIR INFORMATION PRACTICE ACT

In compliance with IC 4-1-6, this agency is notifying you that you must provide the requested information or your application will not be processed.  You have the right to challenge, correct, or explain information maintained by this agency.  The information you provide will become public record.  Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.  Your social security number is being requested by this state agency in accordance with Indiana Code.  Disclosure is mandatory, and this record cannot be processed without it.

A NOTE ABOUT LICENSURE & TEMPORARY PERMITS

Licensure is entirely at the discretion of the Medical Licensing Board of Indiana.  Licensure in another state does not in any manner assure or guarantee licensure in Indiana.  The completion of an application does not guarantee licensure in Indiana.  The issuance of a temporary permit does not in any manner assure or guarantee full licensure in the State of Indiana.

NOTARIZED COPY INFORMATION

When submitting a notarized copy of an original document, the notary MUST make a statement to the fact that the notary has seen the original document.  If this is not done the document will NOT be accepted.

STATUTES AND RULES


You may view the statute and rules on our website.  For your convenience you may clicking here:

POCKET LICENSES AND WALL CERTIFICATES

Once your license is issued you will be notified via email of the license number and given instructions on how you may purchase a wall certificate or pocket license.

**DOCUMENTS REQUIRED FOR LICENSURE**

• COMPLETED APPLICATION FOR LICENSURE

Please type or legible print when completing the application.
All information requested on the application must be completed.
The application must have an original signature and date.
***Please be sure to include a current email address as we will send you status notifications via email.

• FEE

You must submit an application fee in the amount of $40.00; payable to Professional Licensing Agency.  All fees are non-refundable and non-transferable.

* PHOTO

You must submit one (1) passport quality photo taken with in the past three (3) months.

• POSITIVE RESPONSES

If you have answered any of the questions on the application “yes” you must submit a NOTARIZED AFFIDAVIT detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment the amount paid in your behalf.  If applicable please submit copies of all court documents and/or arrest records.  Letters from attorneys or insurance companies are not accepted in lieu of your statement. 

• VERIFICATION OF STATE LICENSURE(S)

You must request a “License Verification or Letter of Good Standing” from each State/Country in which you currently are or have ever been licensed, certified, or registered in any regulated health profession or occupation.  This includes all licenses etc., that are active, expired, inactive, retired, delinquent etc.  In addition to any genetic counselor license/permit etc., this also pertains to any professional health license such as an EMT, Nursing, Pharmacists, etc.  You will need to print off the verification form; contact the appropriate entities/States to see if they charge a fee for completing this form and send the form directly to them.  They will in turn complete the verification and mail it directly to our office.  Click here for the form.
We do not accept web verifications; the verification must be original source verification. 

• OFFICIAL TRANSCRIPT

You must cause the school to submit an official transcript of grades showing that the degree has been conferred and date of graduation from one of the following:
- A master’s degree from a genetic counseling training program accredited by the American Board of Genetic Counseling or its successor; pr
- A doctoral degree from a medical genetics training program that is accredited by the American Board of Medical Genetics or its successor 
Transcripts must come directly from the school in the original/unopened envelope with the school seal.

 

CRIMINAL BACKGROUND CHECK INFORMATION

After June 30, 2011, any physician seeking initial licensure will be required to  submit to fingerprinting and a national criminal background check by the Indiana State Police.  The individual applicant will be responsible for the cost of the background check.  Background checks must be done by the state vendor.  Any checks done without the proper chain of command will not be accepted.  Information on how to be fingerprinted and a list of frequently asked questions may be found at criminal background check information. 

 • EXAMINATION

You must submit one of the following:
- Proof of meeting the examination requirement for certification as a genetic counselor by the American Board of Genetic Counseling or the American Board of Medical Genetics of the successor of those entities or a medical geneticist by the American Board of Medical Genetics or its successor.  Proof of the examination must come directly from one of the above organizations; or
- Proof of current board certification directly from one of the above organizations. 

• TEMPORARY PERMIT

A temporary permit may be issued to an applicant who submits all of the above information with the exception of proof of passing the examination.  An applicant who is applying for a temporary permit must take and pass the next available examination for certification and may only practice under the temporary license if directly supervised by a licensed genetic counselor or licensed physician.

If you are applying for a temporary permit you must submit the following:
     
--  Completed application;
-   Supervisor form;
-   $40 plus, an additional temporary permit fee of $10.00; payable to 
    Professional Licensing Agency.  All fees are non-refundable and non-
    transferable;
- School Transcripts; and
- Proof of Active Candidate Status directly from the American Board of Genetic Counseling.


AMERICAN BOARD OF GENETIC COUNSELING
PO Box 14216
Lenexa, KS  66285
(913) 895-4617
http://www.abgc.net


A temporary license issued under this section expires upon the earliest of the following:
- The date on which the applicant meets the requirements of this chapter to be licensed; or
- The date that is thirty (30) days after the individual fails the examination.


- A supervision contract must be on file with both parties that sets forth the manner in which the supervisor will:
a) Assess and document the professional competence, skill, and experience of the supervisee;
b) Determine the nature and level of the supervision required by the supervisee;
c) Indicate that the supervisor and supervisee will convene monthly to review clinical services and administrative practices;
d) Conduct monthly chart or case reviews; and
e) Provide coverage during absence, incapacity, infirmity or emergency situations.


• PROOF OF NAME CHANGE

When the name on any document differs from the applicant’s name, a notarized or certified copy of a marriage certificate or legal name change must be submitted.

• EXPIRATION DATE

Regardless as to when your license is issued, it will expire on the upcoming June 30th even year.  Example:  License is issued on September 3, 2010 it will expire June 30, 2012; License is issued on March 30, 2012, it will expire June 30, 2012; 
**Licenses issued from May 1st through June 30th of each even year will be issued through to the next even year.  Example:  License issued May 25, 2012 will have an expiration date of June 30, 2014. 

Renewals:  A renewal reminder will be sent out to the address we have on file around April 30th even year.  When you renew your license at this time it will be for a two (2) year period.  Please make sure that IPLA always has your current address.


• CONTINUING EDUCATION

To renew your license, you must have fifty (50) contact hours that been approved by the National Society of Genetic Counselors within the 2 year licensure period.