Apply for Licensure

Fingerprint cards for background checks REQUIRED starting NOVEMBER 1, 2016

**REMINDER**

Incorporation & PLLC renewals will be sent out Late November

 Board Meeting Dates

November 9-10, 2017

February 8-9, 2018

May 10-11, 2018

August 9-10, 2018

November 8-9, 2018

Click Here for deadline dates for submitting materials 

Supervision 

INFORMATIONAL MATERIALS
i Applicant Activities (21 NCAC 54 .2007)
i Licensed Psychologist-Provisional Activities (21 NCAC 54 .2009)
i Psychological Associate Activities (21 NCAC 54 .2006)
i Supervisor and Supervisee Responsibilities
i Maintaining Clear and Accurate Supervisory Records
i Supervision Contract 101: What does interior design have to do with supervision?
i Supervision Report 101: A supervisor's guide to understanding the Supervision Report Form
i Supervision Report 102: A detailed look at the Generic Information & Section 2

FORMS AND INSTRUCTIONS
2 Supervision Contract Form and Instructions
All Applicants, Provisionally Licensed Psychologists, and Licensed Psychological Associates are required to have a Supervision Contract Form on file at all times, regardless of employment setting or activities in which the individual may, or may not, currently be engaged (e.g., unemployment, practice in-state, practice out-of-state, work in another field, etc.).  A Supervision Contract Form must be filed within 30 days of a change in, or termination of, the conditions of the existing contract on file with the Board.  Contracts cover current activities.
2 Supervision Report Form
Reports must be filed within two weeks of a change in, or termination of, the conditions of a Supervision Contract Form already on file with the Board, or within 30 days of notification from the Board that reports must be filed.
2 Alternate Supervision Plan and Requirements
A Licensed Psychological Associate (LPA) may submit an Alternate Supervision Plan that proposes that another LPA be recognized as an appropriate contract supervisor.
2 Supervision Record Form
The Supervisor Record Form is a template that supervisors may use to keep records in accordance with Board Rule .2001(c)(8).

REDUCED SUPERVISION FORMS AND INSTRUCTIONS
Instructions for Reduced Supervision (RS Form#1)
2 Application for Reduced Supervision (RS Form#2)
2 Report for Reduced Supervision (RS Form#3)
 
PLEASE NOTE: All forms are now interactive.  You may open forms using Adobe Reader (follow the link on the sidebar to the left for a FREE download of the latest version) and type directly into the text fields.  While the forms are INTERACTIVE, Adobe Reader will not allow data to be saved upon exit of the program. Individuals are strongly advised to print copies before exiting out of forms.  These forms may not be submitted electronically or by fax. If you have any trouble using the new forms, or have any questions, please contact the Board office.