Wyoming Mental Health Professions Licensing Board

You must download or print the form from the File menu once you have opened the document.  Editing access will not be granted.

Supervision Forms 

Supervision Agreement - To request approval to practice under a supervisor.

VESE Form - To have a supervisor report completed supervision hours.

Addendum to VESE - To  report additional hours from a previous submission. 

Miscellaneous Forms

Address and Name Change Form - To  change your name and/or address with the Board. 

Replacement Wall Certificate or Pocket Card Form - To  request a replacement wall certificate or pocket card.

Verification Form (Wyoming License to another state) - To  request your Wyoming license be verified to another jurisdiction or entity.

Verification of Other State License - To  have another licensing jurisdiction verify your information to Wyoming.

Supporting Documents for Applications

Disclosure Statement Requirements

Proof of Lawful Presence

Training Evaluation - CAPA

Transcript Evaluation - CAP

Transcript Evaluation - CMHW

Transcript Evaluation - LAT

Transcript Evaluation - LPC

Transcript Evaluation - LMFT (enrollment prior to 1/1/2020)

Transcript Evaluation - LMFT (enrollment after to 1/1/2020)