Welcome to the State of California 

APPLICATIONS ARE NOW BEING ACCEPTED. PLEASE USE THE LINK AT THE BOTTOM OF THE PAGE FOR THE CURRENT APPLICATION FORM - PREVIOUS FORMS WILL NOT WORK.  

*NEW* For instructions and forms to use for renewing a California Genetic Counselor License, visit:  http://www.cdph.ca.gov/programs/GDSP/Pages/GCLicenseRenewals.aspx 

The California Department of Public Health Genetic Counselor License Application Process:

  • Complete Genetic Counselor License application (CDPH 4486 - see link at bottom of this page) pages 1-3, signature on page 3 must be in blue ink.
  • If applicable, include official documentation pertaining to questions 1-11.
  • Complete Genetic Counselor License Payment form (CDPH 4487 - see link at bottom of this page) and attach money order or complete VISA/MasterCard information.
  • Provide a 2” X 2” Passport size photo (head and shoulders only) taken within 60 days of filing this application.
  • If applying for a Genetic Counselor License, submit a copy of current certification from American Board of Genetic Counseling (ABGC) or American Board of Medical Genetics (ABMG).
    • Licensure requires that applicants be in "Good Standing" with ABGC (maintaining certification requirements). You can verify your current status by emailing info@ABGC.net.
  • If applying for a Temporary Genetic Counselor License, submit documentation of Active Candidate status and acceptance to take the first available ABGC examination; or documentation that the person meets the requirements to apply to the ABGC certification examination. This includes:
    1. Verification of completion of an American Board of Genetic Counseling (ABGC) accredited genetic counseling training program. Successful completion may be verified by a copy of the Master's diploma, official transcripts, or a letter from the program director or appropriate administrator designated by the degree granting institution; and
    2. A letter from the applicant indicating that they plan to apply to ABGC to sit for the first available certification examination, or for the certification examination in the year following the year of the first available examination; and
    3. The individual must send documentation to the Department showing registration for the examination once the ABGC grants the individual Active Candidate status. The individual must send documentation to the Department after the individual has completed the examination.
  • Complete Live Scan Service process: If you are applying for the Genetic Counselor License or Temporary Genetic Counselor License, a background check is required. A Request for Live Scan Service form can be downloaded from the GDSP website. Please note that some fields have been pre-filled with mandatory information that is not editable. You will need to complete the remainder of the form and make two copies:
  1. Copy (original) of the form is kept by the Live Scan Operator;
  2. Copy of the form is to be attached to the application; and
  3. Copy of the form for your records.

Take all three copies to a local Live Scan site to be fingerprinted. The State CORI fees are included in the license cost, but each Live Scan site charges an individual operator fee for rolling the fingerprint images. These fees vary from site to site. To find a site and its fees visit: http://ag.ca.gov/fingerprints/index.php .

Please note: You must present valid photo identification when being fingerprinted. Expired identification information will not be accepted.

Submit application form (be sure to include your photo), payment form, Request for Live Scan Service form, and all supporting materials to:

    California Department of Public Health
    Genetic Disease Screening Program
    Program Standards and Quality Assurance Branch
    850 Marina Bay Parkway, F-175
    Richmond, CA  94804

    For questions, please call (510) 412-1463

 
 
Last modified on: 8/28/2014 4:35 PM