I, the undersigned, hereby apply for certification as a Certified Rehabilitation Counselor (CRC) in good standing. I understand that the certification process is administered by a private, non-profit voluntary organization representing rehabilitation counselors. I further understand that the Commission on Rehabilitation Counselor Certification (CRCC) is the sole judge of my eligibility for certification and that I have no right to question its discretion in granting or denying certification. I further understand that CRCC reserves the right to request and check references in the course of considering applications for initial certification or certification renewal. As an inducement to the commission and its committees to investigate and reach a determination regarding my character, reputation, and fitness for certification, I hereby release, discharge, and exonerate the commission and its committees, members, agents, and representatives, and any person or entity furnishing documents, records, or other information from any and all liability of every kind and nature arising out of the furnishing, inspection, or use of such documents, records, or information. I understand that should I fail to include required documentation or should CRCC find that the documentation provided is insufficient in order to reach a determination regarding character, reputation, and fitness, CRCC has the right to request additional information. In such an instance, I understand that my file will be deemed incomplete and held for review for the next examination cycle. Further, that should I fail to respond to a request for additional information, CRCC will evaluate the issue of eligibility to seek certification based on the information I initially submitted.

If, in the sole exercise of its discretion, CRCC extends certification to me, I agree to abide by the Code of Professional Ethics for Rehabilitation Counselors, henceforth referred to as the Code, which I have read and understood. I agree and understand that, during the period of time in which my certification is current, CRCC may choose to revoke my certification or suspend it, or otherwise discipline me, for any violation of the Code. In the determination of such discipline, I agree that the decision to discipline or not to discipline shall be solely within the discretion and prerogative of CRCC.

By submission of this application for certification, I specifically waive any right that I may have to seek an external review of any decision, including but not limited to judicial review by CRCC to grant or not to grant, to revoke, suspend, or otherwise affect certification, and/or to impose discipline and otherwise enforce its Code. I specifically release CRCC from any claim that I now have or may in the future have against it for any decision that it has made or will make involving my right to certification and my adherence to the Code. I understand that any complaint that may be filed against me will be considered privileged in any defamation action which I may thereafter bring. I further agree to indemnify and pay CRCC any costs, including attorney’s fees, which it may incur in the defense of its rights as outlined in this agreement. The provisions contained in this application do not preclude an action under state or federal law nor are they applicable to the extent prohibited by such laws.

I understand that information submitted as part of the application, certification and certification renewal processes becomes the property of the commission and will not be released to outside parties unless authorized by the applicant/certificant or unless required by law. I further understand that individual score reports are released to the candidate and are not released to any institution or employer. If a candidate is a student taking the CRC as a comprehensive, then the student may executive proper authorizations so that his/her scores will be provided to the university. I consent that, for research and statistical purposes only, data resulting from the certification process may be used in an anonymous/unidentifiable manner. I understand that the commission does provide a database listing certificants on its website, which is updated periodically, for the use of the public. I further understand that the commission also receives and responds to requests for information about the certification status of those holding its credential.

Before you sign this application, please note that your name will be entered by CRCC as First Name, Middle Initial, and Last Name, according to the information you have listed on page one of this application. This is the way in which your name will be listed on your admission ticket should you be deemed eligible for the examination and on your certificate should you achieve a passing score. If you are deemed eligible to sit for the examination and the name on your valid photo identification does not match the name on your admission ticket, you will not be allowed entry into the examination. Please check your photo identification and make any necessary changes before you mail this application.

Failure to sign the Statement of Understanding will result in the application being deemed incomplete.