Board of Examiners of Psychology
Applications
Applying for initial licensure from your professional licensing board has become a bit easier. 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
- Online Application for Licensure as a Psychologist (PH-1034)
- Paper Application Application for Licensure as a Psychologist (PH-1034)
- Online Application for Certification as a Psychologicial Assistant (PH-3803)
- Paper Application for Certification as a Psychologicial Assistant (PH-3803)
- Reinstatement Application (PH-4049)
- Application for Special Volunteer License (PH-3839)
- Senior Psychological Examiner Application for Upgrade only (PH-3744)
- 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)
Forms
- Affidavit of Supervisor (PH-2970)
- 6 Month Supervision Affidavit
- Postdoctoral Supervised Experience Documentation Form
- Verification of Pre-Doctoral Internship
- Name and Address Change Request (PH-3619)
- Licensure Endorsement Form
- Declaration of Citizenship (PH-4183)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
- Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Criminal Background Check Instructions