Out of State Verification Form
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.
Documents Required for Licensure
- Completed Application - Please be sure to include a current email address as we will send you status notifications via email.
- Fee - $40.00 payable to the Indiana Professional Licensing Agency. All fees are non-refundable and non-transferable.
- Photo - One (1) passport quality photo taken within the past three (3) months.
- Positive Response Documentation - 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 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., which 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 accept official states web verifications; the verification must be original source verification.
- Official Transcript - Transcripts must come directly from the school in the original unopened envelope with the school seal. The official transcript of grades should show that the degree has been conferred and the 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; or
- A doctoral degree from a medical genetics training program that is accredited by the American Board of Medical Genetics or its successor
- Criminal Background Check - After June 30, 2011, any genetic counselor 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.
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 - Found on page 4 of the application.
- Fee - $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
- Proof of Active Candidate Status directly from the American Board of Genetic Counseling
American Board of Genetic Counseling
PO Box 14216
Lenexa, KS 66285
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:
- Assess and document the professional competence, skill, and experience of the supervisee;
- Determine the nature and level of the supervision required by the supervisee;
- Indicate that the supervisor and supervisee will convene monthly to review clinical services and administrative practices;
- Conduct monthly chart or case reviews; and
- Provide coverage during absence, incapacity, infirmity or emergency situations.