Reference Request Form
Certified Ohio Behavior Analyst (COBA) Application
To the Applicant:
Distribute this form to your references. It is also available at
http://psychology.ohio.gov/Applicants/Certified-
Ohio-Behavior-Analyst. Three (3) letters of reference must be received by the Board as part of the COBA
application process. It is the responsibility of the applicant to forward this request to qualified persons for the
purpose of having reference letters sent to the Board. Letters shall come from: (a) A psychologist or a
school psychologist licensed by this board by another jurisdiction; and/or (b) A board certified behavior
analyst (BCBA) in good standing certified by the Behavior Analyst Certification Board; and/or (c) A certified
Ohio behavior analyst; and/or (d) A professional clinical counselor, independent social worker, or
independent marriage and family therapist licensed under Chapter 4757 of the Revised Code. The Board
may request additional letters or information as deemed necessary.
By Board rule references must be “substantially familiar with the applicant’s professional conduct,
competencies, and personal character”
[OAC 4783-1-01 (B)(3)].
To the Reference:
Please provide the Board with a letter regarding this applicant's work experience in applied behavior
analysis (ABA) and his/her ability to function independently as a behavior analyst. Describe the
circumstances under which you have known the applicant. Does the applicant function within acceptable
standards of ethics and professional practice? Does the applicant have the capacity and judgment to restrict
psychological work to the area(s) in which he is competent? Please supply the Board with any other
information that you believe could be useful in evaluating the applicant, including any reservations about
professional judgment or character. With your signature please include your license or certificate
number and the name of the issuing jurisdiction or board.
Your conscientious and prompt reply will not only help the Board in its work but it will be greatly appreciated
by the applicant who is seeking behavior analyst certification in Ohio. A reference letter becomes part of the
application/certification file that is a public record and, as such, is available to the public pursuant to Ohio
public records law.
On behalf of the Ohio Board of Psychology, thank you for your kind attention.
