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
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)
Verification of Active Practice
Examination Forms
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
Licensure/Certification Verification from Another Jurisdiction
Sex Offender Treatment Providers
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 (MS Word document)
Reinstatement Forms
Application for Reinstatement of a Psychologist License (Clinical, Applied, School)
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
Approval Request Report Forms
CE and Education Approval Request
Reports
Miscellaneous Forms
Name and Address Change Form (pdf)
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
Temporary Licenses issued under Executive Order 57
The documents below apply to temporary licenses issued under Executive Order 57.
Licensed Clinical Psychologist
Frequently Asked Questions related to Continuity of Care (pdf)