TX HHS Form 3236. Licensed Chemical Dependency Counselor Licensure by Reciprocity Application

The TX HHS Form 3236, Licensed Chemical Dependency Counselor Licensure by Reciprocity Application, is a crucial document for professionals seeking licensure in the state of Texas. This form helps individuals who have already obtained a chemical dependency counseling license in another state or jurisdiction to obtain a reciprocal license in Texas.

The application requires applicants to provide personal information, including their social security number, date of birth, and sex. Additionally, they must supply educational and license information, such as their highest level of education completed, school name, degree awarded, and major/minor (if applicable). The form also includes a section for the reciprocal credential, which must include the expiration date, issuing authority, and contact information.

The application process is not complete without payment of the required fee, which totals $150 as specified in Texas Administrative Code Title 26. Applicants must also sign a statement acknowledging their understanding of the terms and conditions of licensure, including the release of any relevant information to the Texas Health and Human Services Commission (HHSC). The form emphasizes that all information provided is true and correct, and that intentionally false or misleading statements may result in eligibility for licensure being denied.