The Board of Psychologist and Psychological Associate Examiners

Initial Applications

• Application for Licensure as a Psychological Associate
  #08-4362, Revised 09/28/2023
• Application for Licensure as a Psychologist by Credentials
  #08-4313, Revised 09/28/2023
• Application for Licensure as a Psychologist by Examination
  #08-4113, Revised 09/28/2023
• Application for Psychologist Courtesy License
  #08-4230, Revised 09/28/2023
• Request for Extension on Supervision Plan
  #08-4520, Revised 09/28/2023
  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 09/28/2023

Renewal Applications

• Psychologist License Renewal
  #08-4238, Revised 05/23/2023
• Psychological Associate License Renewal
  #08-4286, Revised 05/23/2023

Miscellaneous Forms

• Courtesy Monthly Report
  #08-4758, Revised 09/28/2023
  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.