Forms: Application | Renewal | Complaint

LICENSE APPLICATION INFORMATION AND FORMS

GENERAL INFORMATION:

At the time of application for licensure, the LSBEP is authorized and empowered to determine that you meet the criteria under LA R.S. 37:2356 or La. R.S. 37:2356.2, including that you are not “in violation of any of the provisions” of Title 37, Chapter 28. Psychologists, specifically, La. R.S. 37:2359(B)(3), (4) and (7) which may be used as a basis to determine eligibility for licensure under La Revised Statutes, Title 37  §§2351 – 2360 and the board’s rules respecting any such health care provider as set forth in LAC 46:LXIII. Pursuant to LA. R.S. 37:33(A)(1), an individual convicted of a crime may submit a Pre-Eligibility Determination Application to request at any time that the LSBEP determine whether an individual’s criminal conviction disqualifies the individual from obtaining a license to engage in the practice of psychology.  In accordance with La. R.S. 37:2950(A)(2), the LSBEP shall consider all of the following in determining whether a conviction directly relates to the practice of psychology: 1)The nature and seriousness of the offense. 2)The nature of the specific duties and responsibilities for which the license is required. 3)The amount of time that has passed since the conviction. 4)Facts relevant to the circumstances of the offense, including any aggravating or mitigating circumstances or social conditions surrounding the commission of the offense. 5)Evidence of rehabilitation or treatment undertaken by the person since the conviction.

APPLICATION FORMS:

RECIPROCITY APPLICATION: You may apply with this workflow ONLY if you are a Diplomate of the American Board of Professional Psychology (ABPP) or a holder of the Certificate of Professional Qualification in Psychology (CPQ) issued by ASPPB. Louisiana does not have reciprocity agreements with individual states or jurisdictions.

TEMPORARY PRACTICE REGISTRATIONS

APPLICATION FOR LICENSED PSYCHOLOGIST: Use this workflow if do not qualify for Reciprocity, and you either 1) have completed the EPPP and postdoctoral supervision requirements; 2) have completed postdoctoral supervision requirements and are seeking approval to be admitted to take the EPPP; or 3) are a qualified applicant for licensure who is not seeking early admission to the EPPP.

APPLICATION FOR PROVISIONAL LICENSE: Use this workflow if you have completed your doctorate degree in psychology through an acceptable institution defined by the Louisiana Administrative Code, Title 46, Part LXIII. Psychologists, Chapter 3. Provisional Licensure REQUIRES Supervision by a Licensed Psychologist in Louisiana. Provisional Licensees are eligible to take the national Examination for Professional Practice in Psychology and Jurisprudence Examination prior to completing the postdoctoral supervision requirements. Applicants may forgo provisional licensure and opt to complete all examination requirements after completing supervision.

LICENSED SPECIALIST IN SCHOOL PSYCHOLOGY (LSSP): This application is for individuals who have completed a school specialist degree from a National Association of School Psychologists approved program or equivalent, three years of supervised as a certified school psychologist within the public school system and has passed the Nationally Certified School Psychologist examination. LSSP's are limited to practice as a contractor or employee of a public, private, or charter school system. Supervision is required outside of these settings.

REINSTATEMENT OF LAPSED LICENSE

TELESUPERVISION

IMPORTANT NOTICE REGARDING TELESUPERVISION OF AN ASSISTANT TO A PSYCHOLOGIST (ATAP): Disclosure of Telesupervision of an Assistant To A Psychologist (ATAP) is included in the initial ATAP Registration and therefore not required in addition to the initial registration. However, if approval for telesupervision was not included in the original application of the ATAP, this form may be used subsequent to the initial registration in order to request approval to provide telesupervision. 

For all other trainees including Postdoctoral Psychology Fellow, Predoctoral Psychology Intern, and Second Year Practicum Student or Higher, use the following application to request an exception to the in person supervision requirements pursuant to LAC:46:lXIII: §1409. Supervision via Telepsychology :

REGISTRATION OF ASSISTANT TO A PSYCHOLOGIST

LICENSEE RENEWAL FORMS  – 

Go to: Licensee page for renewal forms

APPLICATIONS FOR PREAPPROVAL OF CONTINUING PROFESSIONAL DEVELOPMENT ACTIVITIES

  1. SPONSOR Application for CPD Approval
  2. LICENSEE Application for CPD PreApproval

AMERICANS WITH DISABILITIES (ADA)

REQUIRED: PUBLIC DISPLAY OF BOARD ADDRESS

COMPLAINT FORMS

 

NOTICE: In compliance with La. R.S. 44:33.1, the LSBEP hereby gives notice that information submitted to the LSBEP may become public record pursuant to the provisions of Louisiana Public Records Law, La. R.S. 44:1, et seq.