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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

Application for Licensure by Endorsement in Clinical Psychology, School Psychology, or Applied Psychology

Licensure/Certification Verification from Another Jurisdiction (Form 5)

Areas of Graduate Study (Form 6)

EPPP Score Transfer Request Instructions (pdf)

EPPP Score Transfer Request Form (pdf)

Examination Forms

Application for Licensure by Examination for Clinical Psychology, School Psychology, or Applied Psychology

Application for Registration of Post-Degree Supervision

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)

Verification of Pre-Doctoral Supervised Practicum Hours (Form 9)

EPPP Score Transfer Request Instructions (pdf)

EPPP Score Transfer Request Form (pdf)

 

School Psychologist Limited

Application for Licensure as a School Psychologist Limited

Employment Verification Form

Licensure/Certification Verification from Another Jurisdiction

 

Sex Offender Treatment Providers

Application for Certification as a Sex Offender Treatment Provider

Licensure/Certification Verification from Another Jurisdiction

Verification of Post-Degree Supervision

Licensure Verification for Out-of-State Supervisor (Form 7)

Application for Registration of Supervision as a Certified Sex Offender Treatment Provider

 

Reinstatement Forms

Application for Reinstatement of a Psychologist License following Disciplinary Action

Application for Reinstatement of a Psychologist License

Application for Reinstatement of a School Psychologist-Limited License

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

Initial Contact Form

Approval Request Report Forms

CE and Education Approval Request

Evaluator Approval Request

Compliance Supervisor Request

Therapist Approval Request

Reports

Employer Notification Form

Group Attendance Report

Physician Prescription Report

Self-Report

Supervisor Report

Therapy Report (Initial)

Therapy Report (Quarterly)

 

Miscellaneous Forms

Name and Address Change Form (pdf)

Request For Verification Of Virginia Psychology License