The California Department of Public Health Genetic Counselor License Application Process:
1. Complete Genetic Counselor License application CDPH 4486, pages 1-3, signature on page 3 must be in blue ink.
If applicable, include official documentation pertaining to questions 1-11.
2. Complete Genetic Counselor License Payment form CDPH 4487, and attach money order or complete VISA/MasterCard information.
3. Provide a 2" X 2" Passport size photo (head and shoulders only) taken within 60 days of filing this application.
4. When 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.
For Initial (In-state) Applicants only
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. Live Scan center can be found at your local UPS Store.
- Copy (original) of the form is kept by the Live Scan Operator
- Copy of the form is to be attached to the application
- 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; The Agency Billing Number is: 141823 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.
California Department of Public Health
Genetic Disease Screening Program
Program Standards and Quality Assurance Branch
850 Marina Bay Parkway, F-175
Richmond, CA 94804
"If you are having difficulty accessing this document please contact CDPH at (510) 412-6209 or at PSQAGroup@cdph.ca.gov to request this information in an alternate format."