This page contains forms and information required for obtaining and maintaining your psychology license, as well as other public forms.
LICENSE APPLICATION FORMS
General Information for Applicants:
RECIPROCITY APPLICATION: Louisiana accepts this application form if you are a Diplomate of the American Board of Professional Psychology (ABPP) or a holder of the Certificate of Professional Qualification in Psychology (CPQ) issued by ASPPB. Louisiana does not have reciprocity agreements with individual states or jurisdictions. OPEN FOR FORMS...
- Reciprocity Application
- Verification of Professional License
- Doctoral Program (submit form only if Doctoral Program was not APA approved)
- Criminal Background Check
- Specialty Declaration
- Information on Clinical Neuropsychology Specialization
- Clinical Neuropsychology Specialization
TEMPORARY PRACTICE REGISTRATIONS: Louisiana requires the registration of individuals under LA R.S. 37:2365.D. who intend to engage in the practice of psychology, or represent themselves as a psychologist or otherwise qualified to practice psychology; and which practice is of a true temporary nature (i.e. one-time forensic or specialized evaluation, expert witness testimony, facilitate transitions for clients relocating to Louisiana, etc.). Temporary practice may not exceed 30 days in a calendar year and may not be granted more than 3 consecutive years. Additionally, EMERGENCY TEMPORARY REGISTRATIONS are required and accepted ONLY in the event of an emergency declared by the Governor of Louisiana. This registration is available to psychologists who are licensed for independent practice in another jurisdiction of the United States and who are coming to Louisiana to provide services gratuitously through a legitimate relief organization. OPEN FOR FORMS...
- Temporary Registration (30-day temporary practice)
- Emergency Temporary Registration
- Verification of Professional License (Required)
APPLICATION FOR LICENSED PSYCHOLOGIST: This application is available for individuals who are seeking full licensure in Louisiana, who do not qualify for Reciprocity, and who have either a) completed the EPPP and postdoctoral supervision requirements; b) completed postdoctoral supervision requirements and are seeking approval to be admitted to take the EPPP; or c) a qualified applicant for licensure not seeking early admission to the EPPP. OPEN FOR FORMS...
- Licensing Flow Chart – Psychologists w/ 2 years supervised practice experience
- Steps Toward Licensure – Psychologists
- Application Form: Psychologist
- Doctoral Program (submit form only if Doctoral Program was not APA approved)
- Practicum (Required)
- Internship Documentation (Required)
- Criminal Background Check
- Supervised Practice Plan
- Supervised Practice Plan -PROVISIONAL ONLY (Required for Provisional Applicants)
- Post Doctoral Supervision Documentation form (Required)
- Specialty Declaration (Required)
- Verification of Professional License (Required if you are licensed by any other regulatory board)
- Verification of Degree Form (Required if you began your postdoctoral supervision prior to the date your degree was conferred on your transcripts)
- Information on Clinical Neuropsychology Specialization
- Clinical Neuropsychology Specialization
APPLICATION FOR PROVISIONAL LICENSE: This application is available for individuals who have completed their doctorate degree in psychology through an acceptable institution defined by the Louisiana Administrative Code, Title 46, Part LXIII. Psychologists, Chapter 3. Provisional Licensure REQUIRES Supervision by a Licensed Psychologist in Louisiana. Provisional Licensees are eligible to take the national Examination for Professional Practice in Psychology and Jurisprudence Examination prior to completing the postdoctoral supervision requirements. Applicants may forgo provisional licensure and opt to complete all examination requirements after completing supervision. OPEN FOR FORMS...
- Licensing Flow Chart – Provisional Licensure w/ 1 year supervised practice experience
- Steps Toward Licensure – Provisional Licensure
- Application Form: Provisional License
- Doctoral Program (submit form only if Doctoral Program was not APA approved)
- Practicum (Required)
- Internship Documentation (Required)
- Criminal Background Check
- Supervised Practice Plan
- Supervised Practice Plan -PROVISIONAL ONLY (Required for Provisional Applicants)
- Post Doctoral Supervision Documentation form (Required)
- Specialty Declaration (Required)
- Verification of Professional License (Required if you are licensed by any other regulatory board)
- Verification of Degree Form (Required if you began your postdoctoral supervision prior to the date your degree was conferred on your transcripts)
- Information on Clinical Neuropsychology Specialization
- Clinical Neuropsychology Specialization
REQUIRED: PUBLIC DISPLAY OF BOARD ADDRESS
COMPLAINT FORMS
Request for Investigation
Consent Release
LICENSEE RENEWAL FORMS
CONTINUING PROFESSIONAL DEVELOPMENT (CPD) VERIFICATION FORM(To be completed for and retained for your records when claiming credit for peer consultation, continuous practice outcome measure, professional activities, and self-directed learning activities.)
2020 RENEWAL FORMS:
2020 Licensed Psychologist Continuing Professional Development Report
2020 Licensed Specialist in School Psychology Continuing Professional Development Report
2020 Fee Reduction Application
2020 Continuing Education Extension Application
CPD Emergency Rule- Effective 6.1.16
Memorandum: CPD Reporting Requirements for Licensed Psychologists
Memorandum: CPD Reporting Requirements for Former Emeritus/Even Numbered Licenses
NOTICE: In compliance with Act 655 of the 2018 Regular Session, the LSBEP hereby gives notice to its licensees and applicants of their opportunity to file a complaint about board actions and board procedures. You may submit such complaints to one or more of the following organizations: •Louisiana State Board of Examiners of Psychologists:Submit in writing to: LSBEP, 4334 S. Sherwood Forest Blvd., Suite C-150, Baton Rouge, LA 70816; admin.lsbep@la.gov; (225)295-8410 •Committee on House & Governmental Affairs, La. House of Representatives:Submit to: H&GA@legis.la.gov or Committee on House & Governmental Affairs, La. House of Representatives, PO Box 44486, Baton Rouge, LA 70804; (225) 342-2403 •Committee on Senate & Governmental Affairs; La Senate:Submit to: s&g@legis.la.gov or Committee on Senate & Governmental Affairs; La Senate PO Box 94183, Baton Rouge, LA 70804; (225)342-9845
NOTICE: In compliance with La. R.S. 44:33.1, the LSBEP hereby gives notice that information submitted to the LSBEP may become public record pursuant to the provisions of Louisiana Public Records Law, La. R.S. 44:1, et seq.