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OBPE FORMS

HOW TO REQUEST FORMS

The following forms are available for download at this website. Printed copies may be requested from the Oregon Board of Psychologist Examiners:
 
Oregon Board of Psychologist Examiners
3218 Pringle Road SE, Ste. 130
Salem, OR  97302
Phone:  503-378-4154
Fax:      503-374-1904
email:  oregon.bpe@state.or.us

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CONSUMERS

Investigation Request Form - to make a complaint against a licensed psychologist, psychologist associate, psychologist applicant/resident, or a person who may be practicing psychology without a license. Includes the records release authorization form. 
 
List Request Form - to request a list of Oregon licensees/residents/applicants.

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APPLICANTS & RESIDENTS

For application forms (including reference forms), please see Applying for Licensure.
 
For forms pertaining to residency, please see Residency.
 
For visitor's/temporary permit application forms, please see Limited Permits.
 
Change of Name/Address - used to request change of name, address or email.
 
Interim Resident Evaluation
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LICENSEES

Change of Name/Address - used to request change of name, address or email.  Also used to request a wall certificate or license reprint. 
 
Continuing Education Tracking Tool & Audit Report - to maintain proof of continuing education completion. 
 
Renewal Notice and Affidavit- a replacement for those who have misplaced their copy sent from the Board.
 
Diversity Form - optional.  The Board is required to collect this information regarding race, ethnicity, and languages spoken. 
 
Reinstatement Application - for lapsed licenses- use this form if you are past 30 days but within 60 days of your renewal due date.
 
Reactivation Request Form - to request change from inactive status to active or semi-active status.
 
Application/License Information Request - to request copies of information from your file, including application, reference forms, exam scores, etc.
 
Qualified Designated Person Form - to designate a "qualified person" in case of death or incapacity of the licensee.  Required for all licensees.
 
Email Form - to sign up for email notifications.

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