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
Licensure/Certification Verification from Another Jurisdiction
Areas of Graduate Study for Clinical Psychologist
Verification of Active Practice - Clinical Psychologist
Application for Licensure as a Clinical Psychologist by Examination
Application for Initial Registration of Residency for Clinical Psychology
Application for Add/Change Supervisor for Registration of Residency for Clinical Psychology
Verification of Post-Degree Supervision for Clinical Psychology
Internship Verification for Clinical Psychologist License
Licensure/Certification Verification from Another Jurisdiction
Areas of Graduate Study for Clinical Psychologist
Supervisor's Out-of-State Licensure Verification Form
Verification of Pre-Doctoral Supervised Practicum Hours
Sample of a Resident in Clinical Psychology Supervisory Contract
Request for Termination of Supervision - Resident in Clinical Psychology
Request for Change in Status of Virginia Psychology License (Current Inactive to Current Active at Annual Renewal Time)
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
Request for Change in Status of Virginia Psychology License (Current Inactive to Current Active at Annual Renewal Time)
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
Application for Registration as a Sex Offender Treatment Provider Trainee
Application to Add/Change Supervision for a Sex Offender Treatment Provider Trainee
Licensure/Certification Verification from Another Jurisdiction
Supervisor's Out-of-State Licensure Verification Form
Verification of Post-Degree Supervision
Sample of a Sex Offender Treatment Provider Trainee Supervisory Contract
Request for Termination of Supervision - Sex Offender Treatment Provider Trainee
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 of Virginia Psychology License
Request for Change in Status at Renewal - Current Inactive to Current Active
Out-of-state temporary practitioner reporting form
Application for School Psychologist by Endorsement (online application)
Licensure/Certification Verification from Another Jurisdiction
Areas of Graduate Study for School Psychologist
Verification of Post-Licensure Active Practice as a School Psychologist
Application for Initial Registration of Residency for School Psychology (online application)
Application to Add/Change a Supervisor for an existing Residency for School Psychology (online application)
Application for School Psychologist by Examination (online application)
Verification of Post-Degree Supervision for School Psychologist Licensure
Internship Verification for School Psychologist
Supervisor's Out-of-State Licensure Verification Form
Sample of a Resident in School Psychology Supervisory Contract
Request for Termination of Supervision - Resident in School Psychology
Request for Change in Status of Virginia Psychology License (Current Inactive to Current Active at Annual Renewal Time)
Application for Applied Psychologist Licensure by Examination
Area of Graduate Study for Applied Psychologist
Licensure/Certification Verification from Another Jurisdiction
Application for Applied Psychologist Licensure by Endorsement
Licensure/Certification Verification from Another Jurisdiction
Verification of Post-Licensure Active Practice as an Applied Psychologist
Request for Change in Status of Virginia Psychology License (Current Inactive to Current Active at Annual Renewal Time)
Virginia Board of Psychology
psy@dhp.virginia.gov
Jaime Hoyle, Executive Director
J.D. Ball, Ph.D., ABPP, Board Chair