Board of Examiners of Psychology

Applications

Applying for initial licensure from your professional licensing board has become a bit easier.  For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions.  The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check.  You will also be able to upload many of the documents required to complete your initial application!  Please go to the initial application link below to begin the online process.

For mailing documents please send to: Board of Examiners in Psychology; 665 Mainstream Dr.; Nashville TN 37243

•       6 Month Supervision Affidavit     
•       Licensure Endorsement Form
•       Verification of Pre-Doctoral Internship
•       Postdoctoral Supervised Experience Documentation Form
•       Application for Licensure as a Psychologist (PH-1034)
•       Declaration of Citizenship (PH-4183)
•       Declaration of Eligibility for Expedited Licensure Process for a Military Member       (PH-4279)
• Declaration of Eligibility for Expedited Licensure Process for a Spouse of Military Member (PH-4280)
•        Affidavit of Supervisor (PH-2970)
•        Reinstatement Application (PH-4049)
•       Name and Address Change Request (PH-3619)
•       Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
•      Affidavit of Retirement From Practice in Tennessee (PH-3460)
•      Senior Psychological Examiner Application for Upgrade only (PH-3744)
•       Application for Certification as a Psychological Assistant (PH-3803)
•       Criminal Background Check Instructions