Forms

This page contains forms and information required for obtaining and maintaining your psychology license, as well as other public forms.

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...

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.)

2019 Renewal Application

2019 Psychologist Continuing Professional Development Report    

2019 LSSP Continuing Professional Development Report

2019 Fee Reduction Application

2019 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 toH&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 tos&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.