New Hampshire Code of Administrative Rules
Alc - Board of Licensing for Alcohol and Other Drug Use Professionals
Chapter Alc 300 - INITIAL CERTIFICATIONS AND LICENSES
Part Alc 313 - APPLICATION PROCEDURES FOR INITIAL LICENSURE AS A LICENSED ALCOHOL AND DRUG COUNSELOR OR A MASTER LICENSED ALCOHOL AND DRUG COUNSELOR
Section Alc 313.11 - Professional Reference Form

Universal Citation: NH Admin Rules Alc 313.11

Current through Register No. 12, March 21, 2024

(a) Applicants for initial licensure as a licensed alcohol and drug counselor or master licensed alcohol and drug counselor shall give a board-provided professional reference form to 3 individuals in the human services field who can attest to the applicant's professional skills.

(b) Applicants shall request that the individuals completing the professional reference form return the form directly to the board.

(1) The name of the applicant;

(2) The name of the person providing the reference;

(3) The telephone number of the person providing the reference;

(4) The address of the person providing the reference;

(5) The relationship between the applicant and the person providing the reference;

(6) The number of years the applicant has known the person providing the reference;

(7) On the basis of the person providing the reference's knowledge of the applicant, a rating of the applicant's skill in each of the following areas:

a. Common sense;

b. Poise;

c. Enthusiasm;

d. Reliability;

e. Personal and Professional Honesty;

f. Empathy;

g. Ability to work with others;

h. Ethics;

i. Knowledge of alcohol abuse field;

j. Knowledge of drug field;

k. Effectiveness of counseling techniques;

l Appropriateness of counseling approach; and

m. Communication skills; and

(8) The person providing the reference's dated signature and title below the following certification:

"I hereby certify that all of the above information is, to the best of my knowledge, true."

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