Standard forms are hyper-linked within the following instructions.
PLEASE NOTE: While the forms are INTERACTIVE (information may be typed directly into text fields) Adobe Reader WILL NOT allow data to be saved upon exit of the program. The applicant is strongly advised to print copies before exiting out of forms.
Following receipt of the application, the Board may, in some cases, require that additional documentation be submitted. The applicant will be contacted by Board staff if any additional forms or information are needed.
Application for Licensure Form [NOTE: The Board reviews an application for licensure to determine an individual’s eligibility for examination. If approved for examination, the applicant will be sent further materials regarding registering for the examination(s).] Graduates/attendees of online programs
please click here.
Pursuant to G.S. § 90-270.5, persons who are qualified by education to practice psychology in North Carolina must make
application for licensure to the Board within 30 days of offering to practice or undertaking the practice of psychology in
North Carolina. Persons who fail to do so may not subsequently practice or offer to practice psychology without first becoming
licensed. To make application, the following materials are required to be received in the Board’s office:
completed, signed, notarized, application form. The Board suggests that you keep a copy of the completed application form for your records.
completed, signed, notarized, Supervision Contract Form (see Item #3).
non-refundable $100.00 application fee. Make checks or money orders payable to the North Carolina Psychology Board. A $20.00 fee will be charged for any returned bank item.
The Board will acknowledge receipt of the above materials in writing and notify an applicant of any other specific
information required to complete his or her application for review. Also, see NOTE under Item #6 of this set of instructions.
Additional information, including but not limited to the following, will be required for some applicants.
If ever licensed, or having applied for a license, in another jurisdiction, arrange to have the jurisdiction(s) write directly to the NC Psychology Board verifying and reporting on the status of licensure (or application for licensure), including any disciplinary action which is pending or has been taken.
If you have taken the Examination for Professional Practice in Psychology, arrange to have your score reported directly to the NC Psychology Board from the ASPPB Score Transfer Service. Contact ASPPB at 1-800-448-4069 or download a form from the ASPPB website at www.asppb.org to request that your score be reported. (Not required if applying under the Senior Psychologist provision.)
If you hold a diploma from the American Board of Professional Psychology, arrange to have ABPP write directly to the NC Psychology Board to verify your ABPP status.
If you are applying at the Licensed Psychologist level, and you DID graduate from an APA accredited program, arrange to have a letter sent from the head of your APA accredited program directly to the Board which verifies
that you received a doctoral degree from the indicated APA accredited specialty program. If you are applying at the Licensed
Psychologist level, and you did NOT graduate from an APA accredited program, see LP DOC #1
directions for submitting Licensed Psychologist Level documentation, and submit the following:
If applying under the Senior Psychologist provision,
see Item #8 on this sheet.
If you have been convicted of, or entered a plea of guilty or nolo contendere to any felony or misdemeanor other than a minor traffic violation, include a copy of any court document which indicates final disposition of the case.
If you are, or have been, licensed or certified in another field of work; or made application for licensure or certification, arrange to have the applicable source (e.g., board, association, agency) write directly to the NC Psychology Board verifying and reporting on the status of licensure or application, including any disciplinary action which is pending or has been taken.
An application must contain all requested information to be complete, including supervisor and reference forms, transcripts, and any additional information referenced in (c) above. An incomplete application is active for three months from the date of application. At the end of such time if still incomplete, the application becomes void, the applicant is deemed to have discontinued the application process, and must totally reapply. Consequently, the applicant must terminate the practice of psychology, unless otherwise exempt under the Practice Act, and must not practice psychology in North Carolina without first becoming licensed.
It is the applicant’s responsibility to make sure that deadlines are met. Generally, if an application is completed (i.e., all requested application material is received in the Board office) no later than the last working day of the current month, the application will be reviewed by the last working day of the following month. However, in some circumstances, an application file must be reviewed by the full Board. Board meeting and deadline dates are available on the Board’s website by selecting the “Important Dates” link on the side bar, or may be obtained by contacting the Board office.
To confirm receipt of documents by the Board, send by certified mail, return receipt requested.
No application material may be faxed or submitted electronically to the Board.
North Carolina residence is not required to apply for licensure.
NORTH CAROLINA PSYCHOLOGY PRACTICE ACT
The North Carolina Psychology Practice Act governs all of the practice of psychology in this state. The Board is given its authority under this statute, enacted by the state legislature, to regulate the practice of psychology. Many of the application forms refer to specific laws and rules that are found in this document.
SUPERVISION CONTRACT FORM
All applicants are required to have an accurate, up-to-date Supervision Contract Form on file with the Board at all times. This is a requirement regardless of the employment setting or activities in which the applicant may, or may not, currently be engaged (e.g., unemployed, practicing out-of-state, working in another field, etc.). A Supervision Contract Form documents either that supervision is required and being received, OR that supervision is not required.
Print a copy of the Reference Form for each of the required three professional (not personal) references who are familiar with your current work. At least one reference must be from a doctoral level psychologist, and two references may be from other professions. These references must have knowledge of the applicant’s professional skills and competencies within the past year.
Type or print the name of the reference and your name
where indicated.
Send a form to each reference (or refer him/her to where the form is found on the Board website) with instructions to return the completed form to you, the applicant, in a sealed envelope with the reference’s signature over the seal. Forms submitted to the Board office without the reference’s signature over the seal will NOT be accepted.
Individuals completing Supervisor forms CANNOT also serve as references.
Print copies of the Supervisor Form for each direct supervisor, whether administrative or clinical, who is listed on your Application Form (under #18, Experience Section) to cover the entire period of time from the date of application back through, and including, any graduate internship which is associated with the degree upon which you are applying for licensure. To assist your supervisor in reporting the number of hours engaged in the practice of psychology and in health services, you may wish to refer him/her to the question, “What is the difference between health services and the practice of psychology?” under the “Frequently Asked Questions” link on the Board’s website.
Type or print the name of the supervisor and your
name where indicated.
Send a form to each supervisor (or refer him/her to where the form is found on the Board website) with instructions to return the completed form to you, the applicant, in a sealed envelope with the supervisor’s signature over the seal. Forms submitted to the Board office without the supervisor’s signature over the seal will NOT be accepted.
If appropriate, send cover letters informing the supervisor(s) of the date on which you need to receive the form back, reminding them of the approximate dates, hours, and locations of the supervised experience.
If you can no longer locate a supervisor or if a supervisor is deceased, you must arrange to have the Supervisor form completed by someone else at the institution, or by someone who was at the institution when you were supervised, who can verify the experience; or have another state licensing board forward documentation of supervision from your file in their office; and you must provide a written explanation regarding the unavailability of the direct supervisor. If no one can verify the listed supervised experience, you must provide a written explanation. Be aware that such explanations do not assure acceptance of a waiver of this requirement.
If applying under the Senior Psychologist provision,
see Item #8 of these instructions.
TRANSMITTAL FORM
All required supervisor and reference forms must be submitted--in sealed envelopes with the supervisor/reference signature written across the seal (all unsigned envelopes will be returned, which will delay the process)--in one packet directly to the Board by the applicant along with the Transmittal Form. Any written explanation as detailed in
Item #5(e) of these instructions must also accompany this Transmittal Form. [NOTE: It is neither recommended nor necessary to wait until all supervisor and reference forms have been collected to submit the initial Application Form, application fee, and Supervision Contract Form.]
HEALTH SERVICES PROVIDER (HSP) APPLICATION FORM
This certification is in addition to licensure and is mandatory for permanently licensed psychologists who render health services in North Carolina. If the applicant is applying for a permanent psychologist license and his/her pre-doctoral internship was NOT APA accredited, the applicant must complete also
HSP FORM#1 in addition to the HSP Application Form.
Certification is optional at the licensed psychological associate and provisional licensed psychologist levels of licensure. HSP certification does NOT transfer between levels of licensure. The $50.00 application fee must be remitted with each application or reapplication for HSP certification.
SENIOR PSYCHOLOGIST ATTESTATION FORM
Specific requirements for applying under the Senior Psychologist provision are detailed in 21 NCAC 54 .1707 (printed at end of the NC Psychology Practice Act under Selected Board Rules). If applying under this provision, follow ALL instructions for making application with the exception of Item #1(c)(2)
[RE: exam score],
Item#1(c)(4)
[RE: letter regarding APA program/LP DOC forms], Item#1(c)(5) [PA DOC Forms],
and Item #5
[RE: Supervisor Forms]. In lieu of having the Supervisor Forms completed by each supervisor listed on the application form, you will need to complete the Senior Psychologist Attestation Form. Note that you must submit a Supervision Contract Form, even if you are not practicing psychology in North Carolina.
TRANSCRIPTS
Arrange to have ALL graduate college transcripts (whether or not in the field of psychology) sent directly from your school(s) to the Board. Copies submitted by the applicant will NOT be accepted, even if they are in sealed envelopes from the schools. If the applicant has completed ALL requirements for a graduate degree, but the degree is not posted on the transcript, a
VERIFICATION OF DEGREE FORM must be completed.
POST-DOCTORAL EXPERIENCE EXPLAINED
Post-doctoral supervised experience may commence any time after the doctoral degree is awarded. However, applicants who met ALL requirements for their doctorate prior to the degree’s ceremonial awarding may commence their post-doctoral experience anytime after the earlier "met all requirements" date. For those who started their experience early, if a "met all requirements" date is clearly noted on the transcript, no further documentation is required. However, if this date is not on the transcript, a
VERIFICATION OF DEGREE FORM must be completed. NOTE: The Board will accept only the date on which ALL requirements were met. This means that both substantive (including dissertation) AND administrative requirements for a doctorate must be met prior to accruing post-doctoral supervised experience.
EXAMINATIONS
[NOTE: In addition to the following, see examination requirements in 21 NCAC 54 .1900 (printed at end of the NC Psychology Practice Act under Selected Board Rules).]
National Examination. The content outline for the Examination for Professional Practice in Psychology (EPPP) is available on the ASPPB web site at
www.asppb.org.
The EPPP is administered on computer at Prometric Testing Centers throughout the U.S. and Canada. An approved applicant calls a testing site to schedule the examination for his or her chosen location and date. The cost is $650.00 [$600.00 is remitted to the Professional Examination Service (PES), and $50.00 is remitted to the Board as a non-refundable administrative fee]. There is also an additional test administration fee that must be paid to Prometric when scheduling an appoinitment.
State Examination.
The Board-developed State Examination assesses the applicant's knowledge of the
North Carolina Practice Act,
selected rules of the Board covering such topics as education and supervision, and other legal requirements, and the APA Ethics Code. The State Examination is currently
a 50-item, multiple choice examination. Effective June, 2006, the State Examination
will be administered on computer at PSI
testing centers. Upon payment of the $200.00 State Examination fee to the NC Psychology
Board, an applicant who has been approved by the Board for examination will call
PSI to schedule the examination for his or her chosen location and date.
IF YOU DO NOT UNDERSTAND ANY PART OF THE APPLICATION PROCESS, PLEASE CALL THE BOARD OFFICE. FAILURE TO COMPLETE THE PROCESS BY ESTABLISHED DEADLINES AND IN THE REQUIRED FORMAT, INCLUDING HAVING A SIGNATURE NOTARIZED IF SUCH IS REQUIRED ON A FORM, WILL CAUSE A DELAY IN APPLICATION REVIEW AND MAY AFFECT YOUR PRIVILEGE TO PRACTICE PSYCHOLOGY WITHOUT A LICENSE AS AN APPLICANT.