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License Applications
Application for Licensure as a Psychological Associate,
#08-4362, Revised 10/22/09. |
Application for Licensure as a Psychologist by Credentials,
#08-4313,
Revised 10/22/09. |
Application for Licensure as a Psychologist by
Examination, #08-4113, Revised 10/22/09. |
| Application for Psychologist Courtesy License, #08-4230, Revised 06/08/09. |
Request for Extension on Supervision Plan, #08-4520,
Revised 11/07/08. |
Request for Alternate Supervision Plan, #08-4201,
Revised 10/13/08. |
Biennial Psychologist License Renewal, #08-4238, Revised 06/02/09.
This form may be completed online with Adobe Acrobat 6.0 or higher, then printed, signed and mailed.
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Biennial Psychologist Associate License Renewal, #08-4286, Revised 06/02/09.
This form may be completed online with Adobe Acrobat 6.0 or higher, then printed, signed and mailed. |
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Applications
may be viewed and
printed with Adobe
Acrobat Reader
6.0 or higher.
If you do not have
Adobe Acrobat Reader
6.0 or higher,
please click on
the Adobe logo
and download the
free software now.
If you are unable
to view or download
an application,
please contact
us by telephone
or e-mail. Providing
your complete mailing
address will enable
us to mail you
the application.
Other
application forms
may be mailed to
you or picked up
at a division office.
Completed applications
must be signed
and submitted to
the division with
the appropriate
fees.
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