Applications and Forms

• BHA License Application (PDF)
• Mental Health Professional/Mental Health Specialist Application (PDF)
• Administrator Change Notification Form (PDF)
• Voluntary Certification Cancellation Request Form (PDF)
• Deeming Application (PDF)
• Mobile Unit Notification (PDF)

Tribal BHAs applying for licensure and certification may attest that its agency meets the state minimum standards. The department doesn't assert regulatory jurisdiction over a BHA license issued under a tribal attestation. Once the department accepts the tribal attestation, a behavioral health agency license will be issued to the undersigned tribe and include the tribe on the current list of licensed behavioral health agencies (PDF).

• Washington State Department of Health Tribal Attestation for Behavioral Health Agencies: For Substance Use Disorder Services, Mental Health Services, and Licensure (PDF)
• Tribal Application for Behavioral Health Agency License (PDF)
• Tribal Attestation administrative processing fee (PDF)
• Tribal BHA Attestation FAQ (PDF)

Mail completed tribal attestation form, tribal application for BHA license, and administrative processing fee of $261 to:

Department of Health
P.O. Box 1099
Olympia, WA 98507-1099

For questions about tribal attestation, call 360-236-4700.

• BHA License Application (PDF)
• Community Relations Plan (PDF)
• Mobile Unit Notification (PDF)

• Sample Floor Plan (PDF)
• Policies and procedures – All applications for initial licensure and certification or adding services must include the submission of policies and procedures. It's important that your agency's policies and procedures address the requirements in WAC 246-341, and describe how the WAC requirements are implemented at your agency. For example: WAC 246-341 Policy and Procedure Review Tool (PDF).