Application Forms

PSYCHOLOGIST APPLICATION FOR EXAM AND/OR LICENSURE (includes Supervised Temporary Licensure)

Please use this Application Form if you fit into one or more of the following categories:

  • If you have had your doctoral degree conferred, completed 1,500 hours supervised internship experience, and are seeking approval to take the Examination for Professional Practice in Psychology (EPPP), or
  • If you have completed the above, and in addition, have completed 1,500 hours of pre-internship and/or postdoctoral supervised experience(s) and are seeking approval to take the EPPP and obtain Licensure, or
  • If you have passed the EPPP and are seeking Licensure, or
  • If you are already licensed in another state and wish to become licensed in Arizona but are not credentialed by CPQ, ABPP, or NRHSPP, or
  • If you have had your doctoral degree conferred, completed 1,500 hours supervised internship experience, are enrolled in a postdoctoral supervised experience program and are seeking temporary licensure and/or approval to sit for the EPPP. 

 

APPLYING ONLINE?  SCROLL DOWN FOR VERIFICATION AND OTHER FORMS

PLEASE ALLOW UP TO THREE (3) WEEKS FOR PROCESSING AND INTAKE OF YOUR APPLICATION BEFORE REQUESTING AN UPDATE OF THE STATUS.   IT TYPICALLY TAKES TWO TO THREE MONTHS FROM RECEIPT OF APPLICATION TO APPROVAL. A.A.C. R4-26-201 REQUIRES THAT AN APPLICATION BE PLACED ON AN AGENDA IF IT IS ADMINISTRATIVELY COMPLETE 18 DAYS PRIOR TO THE NEXT SCHEDULED BOARD MEETING. WE APPRECIATE YOU PLANNING ACCORDINGLY. 

 

Arizona Revised Statutes §41-1080.01 provides for a waiver of fees associated with initial licensure for qualified applicants. Applicants must have family income that does not exceed 200% of the Federal Poverty Guidelines. If you believe that you qualify for the waiver, please contact the Board office at 602-542-8163 to request the Application for Waiver of Initial Application Fee. 

 

Psychologist Verification Forms: For Psychologist Applications. 

If you are applying via the online Psychologist application, please download and submit the forms below, as applicable. The PDFs are form-fillable. Please use Adobe Acrobat for best experience.  Some fields will not be visible in your browser or via another program/app. 

Core Program Requirements form (needed only if your doctoral program is NOT APA accredited.)

Supervised Preinternship Experience Log (needed only if you are applying preinternship hours towards licensure)

Supervised Preinternship Experience Verification form (needed only if you are applying preinternship hours towards licensure. Must be submitted by your supervisor or director of training directly to the Board's office)

Supervised Psychology Internship or Training Experience Verification form (needed if you are applying via the Psychologist Application for Exam and/or Licensure form and have not been licensed for 20 years)

Postdoctoral Professional Psychology Experience Verification (needed only if you are applying postdoctoral hours towards licensure. Must be submitted by your supervisor directly to the Board's office)

Citizenship Status Form (all applicants are required to provide proof of lawful status in the United States)

PSYCHOLOGIST APPLICATION FOR LICENSURE BY CREDENTIAL

Form for psychologists who hold a: CPQ, NRHSPP, or ABPP credential, and who are licensed in good standing in another state or Canadian province for at least 5 years.
 

BEHAVIOR ANALYST APPLICATION FOR LICENSURE

Behavior Analysts are required to be licensed by the Board of Psychologist Examiners to practice in Arizona.  Please download and complete the Behavior Analyst Application for Licensure linked above. Instructions and requirements are on the first page of the application packet. Updated 06/2019. Current Version has 06/2019 Revised Date. At this time, no online application for Behavior Anaylsts is available.

Arizona Revised Statutes §41-1080.01 provides for a waiver of fees associated with initial licensure for qualified applicants. Applicants must have family income that does not exceed 200% of the Federal Poverty Guidelines. If you believe that you qualify for the waiver, please contact the Board office at 602-542-8163 to request the Application for Waiver of Initial Licensing Fees. 

Behavior Analyst Verification Forms - For Behavior Analyst Application for Licensure

The forms below are also included in the application packet. 

Supervised Work Experience or Independent Fieldwork Verification
(Make as many copies as needed)  If your supervisor will be submitting your BACB Verification forms you used for your BCBA certification, you do not need to submit Arizona's Supervised Work Experience of Independent Fieldwork Verification. Verifications MUST be sent directly from your supervisor to the Board's office. Verifications included with your application will not be accepted.

BCBA Certification Verification form
(follow instructions on the form to submit to BACB for verification that you passed the exam and are BCBA certified. A "Letter of Good Standing" is not required. BACB will email this completed form to the Board's office.)

Citizenship Status Form

LICENSE OR CERTIFICATE VERIFICATION FORM

If you are applying for licensure in Arizona, verification of other licenses/certifications you hold or may have held is required. Please use this form to obtain verification of licensure or certification from other jurisdictions in the United States and Canada in which you hold a license or certificate in psychology, behavior analysis, or any other type of license and/or certification.

Verifications of licensure/certification must be sent directly to the Board office via email, fax (with coversheet), mail or delivery service. Verifications may be submitted by email to [email protected].