Certification

DHS-8069-ENG 4-23

COMMUNITY SUPPORTS ADMINISTRATION – BEHAVIORAL HEALTH

Problem Gambling Training Scholarship Application

Minnesota Alliance on Problem Gambling, Minnesota’s affiliate to the National Council on Problem Gambling, is now administering the Minnesota Department of Human Services scholarship/reimbursement program for qualified clinicians to receive training on becoming a problem gambling counselor. To see more information about the scholarship and requirements, visit https://mnapg.org/certification/.

You may still complete an application through the form below but it is recommended to complete an application through Minnesota Alliance on Problem Gambling directly through their website. All applications submitted to DHS will be sent to Minnesota Alliance on Problem Gambling for follow up.

The Problem Gambling Program unit of the Behavioral Health Division offers scholarship reimbursements for training of qualified clinicians who wish to become a problem gambling treatment service provider. Eligibility requirements to receive a scholarship:

Must be a licensed Minnesota provider serving MN residents.
Must be a fully licensed counselor as an alcohol and drug counselor, a psychologist, a social worker, a marriage and family therapist, psychotherapist, or a psychiatric nurse.
An agency may apply for the scholarship on behalf of qualifying staff.

Per Minnesota Administrative Rule 9585.0040; DHS recognizes training certified by the International Gambling Counselor Certification Board, (IGCCB).

IGCCB has set up approved training programs to enable professionals to identify appropriate training courses that meet the IGCCB standard. Approved status is a mark of quality that the body awards to training programs who meet their standards for training content and delivery.

These courses are 100% virtual

Scholarship applicants must complete at minimum 60 hours of training per Rule 9585.0040, this can be achieved by following the track plan laid out below:

ICGC – I (Sign up for 1 of the currently available training options listed under IGCG I - 30 Hours)
ICGC – II (Sign up for Advanced Training - 20 Hours)
IGCD – Sign up for Intenta: IGDC Training - 15 Hours

Estimated combined 3 course Training Cost: $1,197.00

Combined Total Hours of Training: 65 Hours

IGCCB Trainings are available at https://www.igccb.org/trainings.html

Applicants are encouraged to test out and complete the requirements for ICGC –I or ICGC –II certification however, ICGC certification is not required to qualify as a problem gambling treatment provider in MN.

The Department of Human Services (DHS) is committed to advancing equity, reducing disparities in DHS program outcomes, and improving access to human services for communities experiencing inequities. The DHS Problem Gambling Program will offer full financial support towards the cost of the Problem Gambling Counselor Training.

Farhana Tasmin at 651-431-5696 – Farhana.tasmin@state.mn.us

Applicant Information

1A. APPLICANT FIRST NAME

1B. APPLICANT LAST NAME

2. APPLICANT TYPE

Independent (Mental Health Professional with Clincal License)

Agency (LADC or Mental Health Practitioner working under Licensed Program)

3. APPLICANT EDUCATION DEGREE

4. Credential Type: Provide professional license(s) and certificate(s) numbers for verification

1. LADC

LADC NUMBER

2. MH practitioner - MS 245.462, subd 17, no BA

MH PRACTITIONER NUMBER

3. MN professional - MS 245.462., subd 18

MN PROFESSIONAL NUMBER

5. SUPERVISION PLAN (IF APPLICABLE)

6A. CLINICAL SUPERVISOR NAME

6B. CLINICAL SUPERVISOR CREDENTIALS

7. CLINICAL SUPERVISOR PHONE NUMBER

8. CLINICAL SUPERVISOR EMAIL ADDRESS

9. BUSINESS NAME OF APPLICANT

10. BUSINESS ADDRESS OF APPLICANT

STREET ADDRESS

CITY

STATE

ZIP CODE

COUNTY

PHONE NUMBER

EMAIL ADDRESS

STATE TAX ID

11. DATE PLANNED TO ENROLL IN THE TRAINING PROGRAM

12. DATE OF ANTICIPATED COMPLETION OF TRAINING PROGRAM

I certify that the information provided on this form is true and correct. I will notify DHS Compulsive Gambling Program of any additions or changes to this information as necessary.

APPLICANT EMAIL ADDRESS

APPLICANT SIGNATURE (type name)

SIGNATURE DATE (MM/DD/YYYY)

DHS Use Only

IS APPLICANT PRE-APPROVED FOR SCHOLARSHIP?

Yes

IF YES, AMOUNT APPROVED

EXPLANATION

DHS ACTION

STAFF NAME

STAFF APPROVED DATE

Form State Cd