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.
Please make a selection from the dropdown to view the associated forms.
In addition to downloading the forms listed below, you are required to carefully review the Statutes and Regulations Governing the Practice of Psychology, which can be accessed at this site under Practitioner Resources - Laws and Regulations. These documents include requirements for licensure in the Commonwealth of Virginia and are to be used as a primary guide.
Application for Licensure as a Clinical Psychologist by Endorsement
Application for Licensure as a School Psychologist by Endorsement
Application for Licensure as an Applied Psychologist by Endorsement
Licensure/Certification Verification from Another Jurisdiction
Areas of Graduate Study (Form 6)
Verification of Active Practice - Clinical Psychologist
Verification of Active Practice - School Psychologist
Verification of Active Practice - Applied Psychologist
Application for Licensure by Examination for Clinical Psychology, School Psychologist by Examination
Application for Initial Registration of Residency (Clinical or School Psychology)
Add/Change Supervisor for Registration of Residency (Clinical or School Psychology)
Verification of Post Degree Supervision (Form 3)
Internship Verification (Form 4)
Licensure/Certification Verification from Another Jurisdiction
Area of Graduate Study (Form 6)
Licensure Verification for Out-of-State Supervisor (Form 7)
Verification of Pre-Doctoral Supervised Practicum Hours (Form 9)
In addition to downloading the forms listed below, you are required to carefully review the Statutes and Regulations Governing the Practice of Psychology, which can be accessed at this site under Practitioner Resources - Laws and Regulations. These documents include requirements for licensure in the Commonwealth of Virginia and are to be used as a primary guide.
Application for Licensure as a School Psychologist-Limited
Licensure/Certification Verification from Another Jurisdiction
In addition to downloading the forms listed below, 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.
Application for Certification as a Sex Offender Treatment Provider Packet
Application for Registration of Supervision as a Certified Sex Offender Treatment Provider
Licensure/Certification Verification from Another Jurisdiction
Licensure Verification for Out-of-State Supervisor
Verification of Post-Degree Supervision
Sample of a Sex Offender Treatment Provider Trainee Supervisory Contract
The forms listed below are in PDF format
Application for Reinstatement of a Psychologist License (Clinical, Applied, School) (Not applicable for Psychology temporary COVID licenses.)
Application for Reinstatement of a Psychologist License Following Disciplinary Action
Application for Reinstatement of a School Psychologist-Limited License
Application for Reinstatement of Certification as a Sex Offender Treatment Provider
Continuing Education Summary Form
Form For Reporting Grand Rounds Attendance
CE and Education Approval Request
Request for Board Approval of Evaluator
Employer Notification of Board Order
Request For Verification of Virginia Psychology License
Request for Change in Status - Current Active to Current Inactive
Request for Change in Status - Current Inactive to Current Active
Request for Change in Status at Renewal - Current Inactive to Current Active
Out-of-state temporary practitioner reporting form
Virginia Board of Psychology
psy@dhp.virginia.gov
Jaime Hoyle, Executive Director
Susan Brown Wallace, Ph.D