Genetic Counselor Forms
(Checklist and Forms at bottom of page)
Please read these instructions and the laws/rules governing the practice of Genetic Counselors before completing your application.
There are two types of Genetic Counselor licenses:
- Full License
- Temporary License
Applicants are only eligible for a temporary license if they have been granted an active candidate status by the ABGC. An applicant who is applying for a temporary license must take and pass the examination for certification within eighteen (18) months of the issuance of the temporary license and may only practice if he or she has entered into a genetic supervision contract and is already supervised by a licensed genetic counselor or a licensed physician. A temporary license will expire thirty (30) days after failing to pass the complete certification examination.
All applications are good for one-year only from date of receipt.
APPLICATIONS WILL NOT BE REVIEWED WITHOUT APPLICATION FEE.
It is important to make sure to include your application fee at the time you submit your application. Staff cannot begin the initial review of your application without the fee. Within 10 business days after receipt of your application, a status letter will follow identifying outstanding documentation, if any, to make your file complete. Submit all required documentation as soon as possible. It is recommended that applicants wait 15 business days, after submitting their application, or until receipt of a deficiency letter, to contact the staff by phone regarding the status of their application. It is imperative for applicants to understand that the review process is guided by the requirements set forth in State law, which does not provide for any waivers to be granted by staff.
In order for an application to go before the Medical Board for approval, it must be received as completed 10 business days before the next scheduled board meeting. Completion of an application is when all primary source documentation has been received and reviewed, your application has met all administrative screenings, a final quality assurance review has been completed on your application, and you have been advised in writing from the Board.
INTERNET DISCLOSURE OF GENETIC COUNSELOR ADDRESS
Georgia law requires the Georgia Composite Medical Board to provide, upon written or verbal request, an address for each licensed Genetic Counselor. Public-record information pertaining to licensed Genetic Counselor is available to the public through the Board’s website.
The release of this information has highlighted the need for individuals to carefully consider the address they provide to the Board as their address of record. The address you indicate as your address of record will be the address disclosed to all individuals making inquiries and will be utilized to mail all licenses, renewal notices, and other official correspondence from the Board.
You may choose your home address or your office address to be your address of record. If you list a P.O. Box as your primary address, you must also provide a secondary street address that will remain confidential. Georgia law requires that the Board be kept informed of any changes of address. Changes should be submitted in writing to the above address, and should include the license number, name, old address and new address.
CHECKLIST FOR GENETIC COUNSELORS
This checklist is intended to assist you with the filing of a complete application. Read all instructions on each page carefully and utilize the checklist as you are filling out the application. All items listed that apply to your situation must be submitted in order for your qualifications for licensure to be assessed. When submitting copies of documents, please ensure they are 8-1/2 x11-inch copies of the original. All supporting documentation should be uploaded into online portal when submitting an application.
- Application Fee
- Affidavit of Applicant
- Citizenship Affidavit
- CV or Resume
- American Board of Genetic Counseling (ABGC) or the American Board of Medical Genetics (ABMG) Verification
- Reference Form
- State Board License Verification (not required of all applicants)
- National Practitioner Data Bank Self-Query (not required of all applicants)
- Specific Power of Attorney Form (optional)
Genetic Counselor Forms
Licensure Specialist, Dwana Robinson