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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

Instructions for Application for Licensure by Endorsement

Psychologist Application for Licensure by Endorsement to include CPQ/National Register/ABPP

Licensure/Certification Verification

EPPP Score Transfer Request Instructions (pdf)

EPPP Score Transfer Request Form (pdf)

Areas of Graduate Study Form

EPPP Cut Scores

Examination Forms

Instructions for Application for Licensure by Examination

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)

EPPP Cut Scores

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

Employment Verification Form

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

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

Compliance FAQs

Self Report Form

Clinical Psychologist

Performance Evaluation Form

Supervisor Report Form – Behavioral Sciences

Chaperone Report Form

Miscellaneous Forms

Chaperone Fact Sheet

Drug Log for Prescribers (.xls)

Employer Notified of Board Order

Initial Contact Form

Prescriber Report to Board of Drugs or Prescription Given to Licensee

Recovery Support Group Attendance Log

Name and Address Change Form (pdf)

Request For Verification Of Virginia Psychology License

Approval Forms

Chaperone Approval Request Form

Evaluator Approval Request

Supervisor Approval Request – Behavioral Sciences

Therapist Approval Request