Forms to Become a CCGC-I/CCGC-II

Because application fees are non-refundable, we ask that you review the requirements for the Level I or Level II certifications respectively, and/or contact us to confirm that you meet the minimum requirements before submitting your application.

Application Forms

To apply for California Gambling Counselor Certification please download, complete and submit the below forms, along with your application fee, to CCPG.

Completed by applicant:

• Application (A.1)
• Code of Ethical Conduct (A.2)
• CCGC Directory Authorization (A.3)
• CCPG Website Authorization (F.1)
• (CCGC-II Applicants Only!) Problem Gambling Education Spreadsheet

Certification Forms

Once you have fulfilled the requirements of the certification process please download, complete and submit the below forms, along with your certification fee, to CCPG.

Completed by applicant:

• Tracking Hours Spreadsheet
• Confirmation of Employment on Company Letterhead (For certified counselors working under a licensed professional’s license only)

Completed by applicant’s peers:

• Co-Workers Eval Statement (C.1)
• Co-Workers Eval Statement (C.2)

Completed by applicant’s clinical supervisor:

• Clinical Supervisor Eval Statement (S.1)
• Clinical Supervisor Delineation of Responsibilities (S.2)
• Clinical Supervisor Professional Code and Ethical Standards (S.3)

Completed by IGCC Board Approved Clinical Consultant (BACC):

• BACC Supervisor Eval Statement (S.4)
• BACC Supervisor Delineation of Responsibilities (S.5)
• BACC Supervisor Professional Code and Ethical Standards (S.6)