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:
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:
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 .
- Copy (original) of the form is kept by the Live Scan Operator;
Copy of the form is to be attached to the application; and
Copy of the form for your records.
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