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License Applications
Application for Licensure as a Psychological Associate,
#08-4362, Revised 05/10/13. |
Application for Licensure as a Psychologist by Credentials,
#08-4313,
Revised 05/10/13. |
Application for Licensure as a Psychologist by
Examination, #08-4113, Revised 05/10/13. |
| Application for Psychologist Courtesy License, #08-4230, Revised 05/10/13. |
Request for Extension on Supervision Plan, #08-4520,
Revised 05/10/13. |
Request for Alternate Supervision Plan, #08-4201,
Revised 05/10/13. |
Renewal Applications
Renewal forms for the July 1, 2013 – June 30, 2015 licensing period will be mailed and be available online approximately 30 days before the June 30, 2013 expiration date of your license. Please ensure that the division has your correct address on file.
Contact the division if you need to renew your license for the July 1, 2011 to June 30, 2013 license period.
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| Miscellaneous Forms
Change of Name Form, #08-1431
Change of Address Form, #08-4291
Request for License Verification Form, #08-4222
Request Duplicate License Form, #08-0014
Credit Card Payment Form, #08-4438
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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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