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Form 3C - Verification of Certification by the Behavior Analyst Certification Board

ONLY use this form to verify certification by the Behavior Analyst Certification Board.

This form must be submitted directly by the Behavior Analyst Certification Board. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section before sending the entire form to the Behavior Analyst Certification Board. Be sure to sign and date item 8. 
  • Section II: The Behavior Analyst Certification Board must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.