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:

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 REGISTRATION OF ASSISTANT TO A PSYCHOLOGIST

REGISTRATION OF ASSISTANT TO A PSYCHOLOGIST

LICENSEE RENEWAL FORMS  – Renewals Open July 1, 2023

  • Updated 2023 Renewal Forms will be posted in May 2023
  • 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.)
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.