On this page you will find forms and information required for obtaining and maintaining your psychology license, as well as other public forms.
LICENSE APPLICATION FORMS
Information for Applicants:
- Summary of Fees
- Licensing Flow Chart – Psychologists w/ 2 years supervised practice experience
- Steps Toward Licensure – Psychologists
- Licensing Flow Chart – Provisional Licensure w/ 1 year supervised practice experience
- Steps Toward Licensure – Provisional Licensure
- Information About Applying with PLUS
- Information for Active Duty Military Members and their spouses
LICENSED PSYCHOLOGIST AND PROVISIONAL LICENSED PSYCHOLOGIST
- Application Form: Psychologist and Provisional Psychologist
- Doctoral Program (submit form only if Doctoral Program was not APA approved)
- Practicum (Required)
- Internship Documentation (Required)
- Criminal Background Check
- Supervised Practice Plan
- Provisional Licensure -Supervised Practice Plan (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)
- Clinical Neuropsychology Specialization and Information on Clinical Neuropsychology Specialization
- Clinical Neuropsychology Specialization
RECIPROCITY APPLICATION
- Reciprocity Application (Available if you are a Diplomate of the American Board of Professional Psychology (ABPP); or if you are a holder of a Certificate of Professional Qualifications (CPQ) through the Association of State and Provincial Psychology Boards (ASPPB).
- Verification of Professional License
- Doctoral Program (submit form only if Doctoral Program was not APA approved)
- Practicum (Required)
- Internship Documentation (Required)
- Criminal Background Check
- Post Doctoral Supervision Documentation form (Required)
- Specialty Declaration (Required)
- Verification of Degree Form (Required if you began your postdoctoral supervision prior to the date your degree was conferred on your transcripts)
- Clinical Neuropsychology Specialization and Information on Clinical Neuropsychology Specialization
- Clinical Neuropsychology Specialization
REINSTATEMENT OF LAPSED LICENSE
- Reinstatement Application
- Verification of Professional License
- CPD Verification Form
- Criminal Background Check
TEMPORARY PRACTICE REGISTRATIONS
- Temporary Registration (30-day temporary practice)
- Emergency Temporary Registration 2016
- Verification of Professional License (Required)
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.)
2018 Psychologist Continuing Professional Development Report
2018 LSSP Continuing Professional Development Report
2018 Fee Reduction Application
2018 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