Text Size:   A+ A- A   •   Text Only
Site Image



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

Back to Top


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.

Back to Top


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
Back to Top


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. 
Replacement Renewal Form- for those who have misplaced the form 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.