The Board of Psychologist and Psychological Associate Examiners

Applications

• Application for Licensure as a Psychological Associate
  #08-4362, Revised 05/12/2019
• Application for Licensure as a Psychologist by Credentials
  #08-4313, Revised 05/12/2019
• Application for Licensure as a Psychologist by Examination
  #08-4113, Revised 05/12/2019
• Application for Psychologist Courtesy License
  #08-4230, Revised 12/12/2013
• Request for Extension on Supervision Plan
  #08-4520, Revised 05/10/2013
  The Request for Extension on Supervision Plan form may also be initiated online via the MY LICENSE self-service portal.
• Request for Alternate Supervision Plan
  #08-4201, Revised 05/10/2013

Renewal Applications

Renewal applications will be available no later than May 31, 2023, in accordance with AS 08.01.050. Please note, you must wait for an updated renewal application to renew your license. You cannot renew your license using any prior renewal forms. If you need to renew your license for the current licensing period (07/01/2021 – 06/30/2023), email BoardofPsychologists@Alaska.Gov to request the appropriate form. To ensure receipt of renewal notifications and other correspondence from our office, please go to MY LICENSE and confirm your current mailing address is on file.

Miscellaneous Forms

• Statement of Supervised Psychological Experience
  #08-4113f, Revised 07/18/2014
• Courtesy Monthly Report
  #08-4758, Revised 11/24/2020
  The Courtesy Monthly Report form may also be initiated online via the MY LICENSE self-service portal.

Division forms may be found in the CBPL Quick links, located in the sidebar to the right.