Credential Application and/or Exam Fee Payments


Instructions

Advanced and specialty credentials from Breining Institute demonstrate your commitment to providing quality care to your clients, beyond the basic certification or license you may need to work in your State or other jurisdiction.

After you have submitted your Credential Application, you may use this online form to provide payment information to Breining Institute.

Use this online form to submit your payment information using a VISA, MasterCard or Discover credit card. If you prefer to pay by check, please complete and print this form, and then send it to us by postal mail to: Breining Institute, 8894 Greenback Lane, Orangevale, California USA 95662


Payment Options:

You may use this form to authorize credit card payments for any of the following charges that are applicable to you, which you will select at the “Payment Information” section of this form.

  • Addiction Counselor Exam (ACE): $175
  • Private-practice / Clinical Supervisor (PCS) Exam: $175
  • Forensic Addictions Counselor (FAC) “Test-in” Option: $79
  • Forensic Addiction Counselor (FAC) Application Fee: $76
  • Certified Co-occurring Disorders Specialist (CCDS) “Test-in” Option: $89
  • Certified Case Manager Interventionist (CCMI) Application Fee: $75
  • Certified Case Manager Interventionist (CCMI) Exam Fee: $175

IMPORTANT NOTICE: Applications or exam requests that require payment will not be processed until payment is confirmed.

Applicant Info

Applicant Information
Please re-enter your email address here

Payment Info

Payment Information
Credit Card Charge Authorization

Please be careful to input all information carefully, in order to for us to promptly process your payment.

If you have made multiple selections, such as paying for the CCMI Application and CCMI Exam Fee, your card will be charged the total of the amounts selected.

Please double check to ensure you have selected only those items for which you wish to be charged.

By submitting this form, I attest that the information I have provided above is true and authentic. I authorize Breining Institute to charge the above-selected amount(s). I attest that I will adhere to the applicable Code of Ethics, Code of Conduct, and Scope of Practice related to my credential. I understand that if at any time it is determined that the information provided is materially misrepresented, any fees which have been paid will be forfeited, and registration, certifications and/or credentials may be revoked.

Please carefully use this space to sign your name, which must match the signature we have on record in your credential file.
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