Psychology Licensure By Endorsement: Instructions



VIRGINIA BOARD OF PSYCHOLOGY APPLICATION

FOR LICENSURE BY ENDORSEMENT

Submit application and all materials in one package.

Incomplete packages: payment will be processed and application will be returned to the applicant.

This application package is to be used to apply for clinical psychology, school psychology, or applied psychology licensure by endorsement. All forms may be duplicated. The Board may waive the Virginia licensure examinations for individuals who meet the criteria in one of following categories:

|National Register Of Health Services Provider |Diplomate Status With ABPP |

|Completed and notarized application |Completed and notarized application |

|Application fee |Application fee |

|Licensure/Certification Verification (s)* |Licensure/Certification Verification (s)* |

|Verification of listing in the National Register of Health Services |Verification of diplomate status with ABPP* |

|Providers* | |

|Twenty Years Of Active Licensure |Five Of The Last Six Years Of Active Licensure |

|Completed and notarized application |Completed and notarized application |

|Application fee |Application fee |

|Licensure/Certification Verification (s)* showing twenty years of active |Licensure/Certification Verification (s)* |

|licensure in category comparable to licensure sought. |Documentation of current licensure with post-licensure active practice for |

|An official transcript * |five of the last six years. |

| |Verification of passing score on state examination(s) required for |

|Certificate of Professional Qualification in |licensure* |

|Psychology (CPQ) |National examination (EPPP) scores* |

| |Completed Areas of Graduate Study form |

|Completed and notarized application |An official copy of the original application from the out-of-state |

|Application fee |licensing agency* or |

|Licensure/Certification Verification (s)* |A copy of the regulations in effect at the time of initial licensure |

|Verification of CPQ* |An official transcript * |

| | |

* In the original unopened envelope. For transcripts, request Registrar to stamp the seal.

PLEASE NOTE:

← All applicants are required to submit a current report from the Healthcare Integrity and Protection Data Bank (HIPDB) and a current report from the National Practitioner Data Bank (NPDB).

← Applicants are requested to review thoroughly the Regulations Governing the Practice of Psychology to determine eligibility for licensure prior to applying, as fees are non-refundable.

← Credentials Reviews are held in the middle and the end of each month to review completed applications.

AND FINALLY...

The applicant is responsible for submitting ALL the required documentation simultaneously (in one package) to the Board office. APPLICATIONS SUBMITTED WITHOUT APPROPRIATE FEES WILL NOT BE PROCESSED, BUT RETURNED TO APPLICANT. ALL FEES ARE NON-REFUNDABLE.

( In accordance with Section 54.1-116 of the Code of Virginia you are required to submit your Social Security Number or your Virginia control number issued by the Virginia Department of Motor Vehicles. Failure to do so will cease the processing of your application. Fees will not be refunded. This number will be used by the Department of Health Professions for identification and will not be disclosed for other purposes except as provided for by law. Federal and state law requires that this number be shared with other agencies for child support enforcement activities.

Rev. 5/2012

APPLICATION CHECKLIST

A. Hold a current listing in the National Register of Health Services Providers in Psychology.

Submit the following materials in your application package:

_______ Completed and notarized application with fee (Form 1)

_______ Licensure/Certification Verification from all other jurisdictions (Form 2)

_______ Current HIPDB and NPDB report

_______ Official verification of National Register listing in original unopened envelope.(; 202/783-7663).

B. Hold current diplomate status in good standing with the American Board of Professional Psychology in the category of licensure sought.

Submit the following materials in your application package:

_______ Completed and notarized application with fee (Form 1)

_______ Licensure/Certification Verification from all other jurisdictions (Form 2)

_______ Current HIPDB and NPDB report

_______ Official verification of ABPP diplomate status (; 573/634-5607).

C. Have 20 years of active licensure and an appropriate degree in the category of licensure sought.

Submit the following materials in your application package:

_______ Completed and notarized application with fee (Form 1)

_______ Licensure/Certification Verification from all other jurisdictions showing twenty consecutive years of active licensure (Form 2)

_______ Current HIPDB and NPDB report

_______ Official transcript showing the degree required in Virginia for the category of licensure sought.

D. Have been in active licensed practice for at least five of the last six years.

Submit the following materials in your application package:

_______ Completed and notarized application with fee (Form 1)

_______ Licensure/Certification Verification from all other jurisdictions showing active licensure for the past 5 years and of a passing score on examinations as required by that jurisdiction. (Form 2)

_______ Current HIPDB and NPDB report

_______ Verification of a passing score on the Examination for Professional Practice in Psychology sent directly from Licensed Psychologists Data Source (request form enclosed)

_______ Certified copy of the original application from the out-of-state licensing agency to the or a copy of the regulations in effect at the time of initial licensure.

_______ Areas of Graduate Study (Form 3)

_______ Official transcript showing the degree required in Virginia for the category of licensure sought.

E. Hold a Certificate of Professional Qualification in Psychology.

Submit the following materials in your application package:

_______ Completed and notarized application with fee (Form 1)

_______ Licensure/Certification Verification from all other jurisdictions (Form 2)

_______ Current HIPDB and NPDB report

_______ Official verification of CPQ listing in original unopened envelope.

(; 334-832-4580).

Rev. 5/2012

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