Virginia Board of Psychology
Applications & Forms
The below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000. For PDF files, you'll need the free Adobe Acrobat Reader.
In addition to downloading the forms listed under Psychology Forms, you are required to carefully review the Statutes and Regulations Governing the Practice of Psychology, which can be accessed at this site under Laws and Regulations Governing Psychology. These documents include requirements for licensure in the Commonwealth of Virginia and are to be used as a primary guide.
Psychologist Forms
Endorsement Forms
Psychologist Application for Licensure by Endorsement to include CPQ/National Register/ABPP
Application for Licensure by Endorsement Instructions
Licensure/Certification Verification
EPPP Score Transfer Request Instructions (pdf)
EPPP Score Transfer Request Form (pdf)
Examination Forms
Psychologist Application for Licensure by Examination (Form 1)
Post Degree Supervision Registration - Registration of Residency (Form 2)
Verification of Post Degree Supervision (Form 3)
Internship Verification (Form 4)
Licensure/Certification Verification from Another Jurisdiction (Form 5)
Area of Graduate Study (Form 6)
Licensure
Verification for Out-of- State Supervisor (Form 7)
EPPP Score Transfer Request Instructions (pdf)
EPPP Score Transfer Request Form (pdf)
Verification of Pre-Doctoral Supervised Practicum Hours
Reinstatement Forms
Application for Reinstatement following Disciplinary Action
Application for Reinstatement of a Lapsed License
School Psychologist Limited
Instructions for completing an application for School Psychologist Limited
Application for Licensure as a School Psychologist Limited
School Psychologist-Limited Application for Reinstatement of a Lapsed License
Sex Offender Treatment Providers
General Information for Certification as a Sex Offender Treatment Provider
Application for Certification, (Form 1)
Licensure/Certification Verification, (Form 2)
Registration of Supervision Instructions and Verification of Post-Degree Supervision, (Form 3)
Licensure Verification for Out-of-State Supervisor (Form 4)
Registration of Supervision for Sex Offender Treatment Providers
Application for Reinstatement of Certification as a Sex Offender Treatment Provider
Licensee Continuing Education Forms
Continuing Education Experience Summary Form
Form For Reporting Psychology Grand Rounds Attendance
Compliance Forms & Information
Self Report Form
Performance Evaluation Form
Supervisor Report Form – Behavioral Sciences
Miscellaneous Forms
Drug Log for Prescribers (.xls)
Employer Notified of Board Order
Prescriber Report to Board of Drugs or Prescription Given to Licensee
Recovery Support Group Attendance Log
Approval Forms
Chaperone Approval Request Form