Forms [Application, Renewal and Complaint]

COMPLAINT FORMS

Request for Investigation
Consent Release

2021 LICENSEE RENEWAL FORMS

CONTINUING PROFESSIONAL DEVELOPMENT (CPD) VERIFICATION FORM(To be completed for and retained for your records when claiming credit for peer consultation, continuous practice outcome measure, professional activities, and self-directed learning activities.)

2021 Renewal Application

2021 Licensed Psychologist Continuing Professional Development Report

2021 Licensed Specialist in School Psychology Continuing Professional Development Report

2021 Fee Reduction Application

2021 Continuing Education Extension Application

NOTICE: In compliance with Act 655 of the 2018 Regular Session, the LSBEP hereby gives notice to its licensees and applicants of their opportunity to file a complaint about board actions and board procedures. You may submit such complaints to one or more of the following organizations:
•Louisiana State Board of Examiners of Psychologists:Submit in writing to: LSBEP, 4334 S. Sherwood Forest Blvd., Suite C-150, Baton Rouge, LA  70816; admin.lsbep@la.gov; (225)295-8410
•Committee on House & Governmental Affairs, La. House of Representatives:Submit toH&GA@legis.la.gov or Committee on House & Governmental Affairs, La. House of Representatives, PO Box 44486, Baton Rouge, LA 70804; (225) 342-2403
•Committee on Senate & Governmental Affairs; La Senate:Submit tos&g@legis.la.gov or Committee on Senate & Governmental Affairs; La Senate PO Box 94183, Baton Rouge, LA 70804; (225)342-9845
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.