State Board of Psychological Examiners
Applications and Forms
Page Content
Unless specifically directed to do so by Board/Committee staff,
do not mail your application and/or request to the Board/Committee office.
Initial Applications
One-Year Permit, Three-Year Permits, Licensed Psychologist Application -
Register on our website and submit your application online
- All third party documents including official transcripts, license/certificate verifications are to be emailed to
PsychologyApplications@dca.njoag.gov
- Inquiries about the application process can be sent to
PsychologicalExaminers@dca.njoag.gov
Miscellaneous Application Forms- Fill out
(or have the appropriate party fill out) the required form, links below:
-
Certificate of Good Moral Character
-
Supervisory Form for Psychology Candidates
-
Application for Proposed Supervisors(There is a $50.00 fee per additional supervisor).
- Upload completed form and any supporting documents to your
online profile through the
Upload License Documents tab.
- If there is a fee associated with your application you will be emailed an invoice with instructions to pay the outstanding fee.
- All subsequent inquiries should be sent to
PsychologicalExaminers@dca.njoag.gov
Name Change Request- Write a letter which must include the following information:
- current name;
- new name; and
- whether you are also requesting a duplicate license be printed with new name.
- Scan letter and all supporting documents
(marriage license, divorce decree, or court order) to your
online profile through the
Upload License Documents tab.
- If requesting a duplicate license you will be emailed an invoice for $25 and instructions to pay.
- Follow up inquiries may be sent to
PsychologicalExaminers@dca.njoag.gov
License Verification Requests- Reach out to the requesting board/jurisdiction and obtain an email address to where we can send electronic verification.
We can only provide electronic verification at the time.
- Formulate your written/signed request for an out-of-state verification.
- Your request must include:
- your New Jersey license/certificate number;
- your mailing address;
- your e-mail address; and
- the e-mail address where verification is to be sent.
- If the other state requires completion of a specific form,
complete the part of the form pertaining to "Applicants" before submitting it for the Board's completion.
- Upload your request and any document that you may require us to fill out for verification to your
online profile through the
Upload License Documents tab.
- Once the request is processed, you will be sent an email with an invoice and instructions for payment. The fee for each request is $35.
- Incomplete requests will delay the processing of the verification.
- All subsequent inquiries should be sent to
PsychologicalExaminers@dca.njoag.gov.
Duplicate License Request- Write a letter which must include the following information:
- your name;
- license number;
- address of record;
- mailing address; and
- reason for requesting duplicate license
(lost, stolen, never received).
- Upload completed form to your
online profile through the
Upload License Documents tab.
- You will be emailed an invoice for $25 and instructions for payment.
- All subsequent inquiries should be sent to
PsychologicalExaminers@dca.njoag.gov.
Applications for Reinstatement/Reactivation- Fill out and upload this
Reinstatement/Reactivation application and any requested supporting documentation to your online profile through the Upload License Documents tab. If you do not have an online profile set up already, you will need to create one.
- Send an email to
PsychologicalExaminers@dca.njoag.gov and in the subject line type
Reinstatement/Reactivation Application submitted to let us know you have submitted your application.
- After we review your application, you will be emailed the appropriate invoices for the outstanding fees. Please visit our regulations to view the fees for reactivation/reinstatements.
- All subsequent inquiries should be sent to
PsychologicalExaminers@dca.njoag.gov.
To Check the Status of Your Application- Log into your
online profile.
- On the application type you wish to see click on
View Checklist.
- Items that do not have a complete date next to them are still missing.
- You may upload missing items to your online profile through the
Upload License Documents tab
except for third party documents
(transcripts, license verifications) which should be received directly by the Board from those entities and are to be emailed to
PsychologicalExaminers@dca.njoag.gov.
- Inquiries about the status of your application can be sent to
PsychologicalExaminers@dca.njoag.gov.
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Last Modified: 8/9/2023 9:57 AM