Application Forms - as of 9/30/17

• Application Form: License/Registered Intern (Form 1)

• Post-Degree Supervised Work Experience (Form 2)  >>See note below.
• Degree Program Direct Client Contact Hours (Form 2A)
• Examination Verification (Form 3)
• Verification of Licensure (from another state) (Form 4)
• Professional Disclosure Statement
• Graduate Degree Information (Form 6A)
• Intern Supervised Clinical Experience Plan (Form 7)

Renewal Forms 

• 2017 Generic_License_Renewal
• Health Care Workforce Questionnaire- Required for license renewal.  Interns, please DO NOT complete the survey.
• 2017 Generic_Intern_Renewal

Please contact Board office if 2016 form is required.