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Get and Sign Application Packet Credentialed Alcoholism and Substance Abuse Counselor Form

OR FEDERAL AGENCY Yes - If Yes complete the following information and attach supporting documentation. Date of Disciplinary Action License or Certification Type of Action Taken I attest that the information contained in this Application including any attachments is true and correct to the best of my knowledge. I understand that if the information submitted contains a false statement my CASAC Application may be denied. If the to duly annul suspend limit or revoke the credential issued....

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