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.
Confidential Report Form
- to make a complaint against a licensee, including mandatory/self reports, or against a person who may be practicing psychology without a license. Includes the records release authorization form. Replacement Renewal Form
- for those who have misplaced the form sent from the Board.
- 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.