Instructions for Psychologist Application for Licensure by Credential
Use this form if you hold one of the following credentials:
- American Board of Professional Psychology (ABPP) Specialist (Diplomate)
- Certificate of Professional Qualification in Psychology (CPQ)
- National Register of Health Service Psychologists (NRHSP)
Membership in APA does not qualify as a credential. If you do not hold one of these credentials, please DO NOT USE THIS APPLICATION. Please use the standard Psychologist Application for Exam and/or Licensure or if you qualify, the Universal Recognition application.
The following is an application for psychologist licensure by credential, pursuant to A.R.S. 32-2071.01(A). Please read these materials carefully as lack of familiarity with the requirements may cause delays in the application process. This form may change without notice.
An application file is considered open upon receipt of the appropriately completed application and non-refundable fee, but is not considered administratively complete for review by the Board until all documents have been received in the Board's office.
All documents not uploaded with this application may be sent by email to [email protected].
For questions, please email Kathy Fowkes, Licensing Specialist, at [email protected].
Documents to Be Submitted
The following documents will be required to be uploaded to complete and submit this application. You must upload a high quality PDF for text documents. IDs and photos should be high resolution .jpg or .jpeg. Please DO NOT resize jpgs.
Photograph - One original, "passport quality" photograph taken not more than 60 days before the date of application submission. This may be a selfie taken with your phone as long as it is high resolution, head and shoulders, facing front, plain background, in focus, good lighting, etc. Photos with your head tilted, or the top or side of your head/face not in the picture will be rejected. You can crop your image, but please do not shrink the size of the image before uploading. Full length snapshots, newsprints, negatives or proofs are not acceptable.
National Practitioner Data Bank Self-Query - Please provide a PDF copy of a new self-query from the National Practitioner Data Bank (NPDB). The processing date in the upper right corner of the self-query must within 30 days of your application submission date in order to be valid. Upload the original PDF you download from the NPDB's website. Do not upload a copy or an image - the official document with digital signature from the NPDB is required.
Evidence of Citizenship or Alien Status - Provide a high-quality photo or scan of your Real ID, US Passport or other current government issued picture ID from the Evidence List on Page 3 of the Arizona Statement of Citizenship and Alien Status form.
Appropriate Documentation for Yes Answers on Declaration questions - You will be asked to upload additional documentation relating to any "yes" responses in the Declaration section of this application. For more information on the documentation and/or evidence that an applicant must submit to the Board, review the Appropriate Documentation for 'Yes' Answers form.
Documents to Be Sent by Verifier
All of the documents listed below must be sent by the appropriate information sources, NOT the applicant. DO NOT include the below documents with your application. The AZ Board prefers verifications be sent by email to [email protected] to expedite this process.
It is the applicant's responsibility to contact information sources to verify that materials have been sent. Board staff will not send application documents to information sources. It is the applicant's responsibility to make sure that all information sources are aware of any deadlines that the applicant is attempting to meet. Applications must be administratively complete in order to be scheduled on a meeting agenda. Applicants should also be aware that the Board may request clarification or additional information regarding pending applications. The Board provides the applicant one Notice of Incomplete Application for materials that have not been received. It is the applicant's responsibility to login to the Applicant Portal periodically to check the status of the application file.
Verification of Credential(s) - Verification of one of the following credentials: American Board of Psychology (ABPP) Specialist (Diplomate), Certificate of Professional Qualification in Psychology (CPQ), or National Register of Health Service Psychologists (NRHSP) credential must be sent directly from the certifying organization to the Board's office to [email protected].
Verification of Psychology Licenses - Verification of all psychology licenses ever held in other states, whether active, inactive, expired, or otherwise, must be sent directly to the Board of Psychologist Examiners by the appropriate jurisdiction. You must be licensed in another state or Canadian province for five (5) or more years to qualify for licensure by credential. Verification of any licenses or certifications held in any other field(s) or profession(s) must also be sent directly from the state licensure Board to [email protected].
EPPP Score Transfer - If your credential is from the National Register (NRHSP), you must also contact ASPPB to request transfer of your EPPP scores to Arizona. This is not required for CPQ or ABPP.
STATUTES AND RULES
Arizona licensees are expected to know the statutes and rules regulating the practice of Psychology in Arizona. You may download a free copy of the Statutes and Rules from the Board's website.
CONTACTING THE BOARD
Arizona Board of Psychologist Examiners
1740 West Adams Street, Suite 3403
Phoenix, Arizona 85007
NOTICE FOR AMERICANS WITH DISABILITIES
Title II of the Americans with Disabilities Act (ADA) prohibits the Board from discriminating on the basis of disability in its public meetings. Persons with disabilities may request reasonable accommodations by contacting the Board at (602) 542-8162 to make their needs known. Requests should be made as soon as possible to allow time to arrange for accommodations. These documents may be made available in alternative formats by contacting the Board.
With respect to licensing decisions, please note that A.R.S. §41-1030 provides that:
B. An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or condition.
D. This section may be enforced in a private civil action and relief may be awarded against the state. The court may award reasonable attorney fees, damages and all fees associated with the license application to a party that prevails in an action against the state for a violation of this section.
E. A state employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action or dismissal pursuant to the Agency's adopted personnel policy.
F. This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02.
Pursuant to Section 41-1093.01, Arizona Revised Statutes, an agency shall limit all occupational regulations to regulations that are demonstrated to be necessary to specifically fulfill a public health, safety or welfare concern. Pursuant to Sections 41-1093.02 and 41-1093.03, Arizona Revised Statutes, you have the right to petition this agency to repeal or modify the occupational regulation or bring an action in a court of general jurisdiction to challenge the occupational regulation and to ensure compliance with Section 41-1093.01, Arizona Revised Statutes.