APPLICATION TO REQUEST APPROVAL TO SIT FOR THE PSYCHOLOGY LICENSING EXAMINATIONS - PSYCHOLOGY (App#863-107 ) - CHECKLIST

Sep 17, 2026

Uploaded by Logic

Application packet for first-time psychology licensure exam approval and practice license eligibility through the State Board of Psychology. The form specifies doctoral degree accreditation requirements (APA or ASPPB/NRDP), supervised experience starting on or after December 6, 2010, and provides a detailed submission checklist. Required items include application fee, name-change legal documentation if applicable, mandatory child-abuse training, criminal background check, child abuse history clearance, NPDB self-query, official sealed transcripts, accreditation verification and internship form, and supervised-experience verification with hours and duration.

LanguageEnglish

CategoryExam

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Checklist

Required documents and fees

Eligibility review and exam application flow

STATE BOARD OF PSYCHOLOGY P.O. Box 2649 Harrisburg, PA 17105-2649 Telephone: (717) 783-7155 Courier Address: Fax: (717) 787-7769 2601 North Third Street Website: [www.dos.pa.gov/psych](www.dos.pa.gov/psych) Harrisburg, PA 17110 E-Mail: [st-psychology@pa.gov](st-psychology@pa.gov) APPLICATION TO REQUEST APPROVAL TO SIT FOR THE PSYCHOLOGY LICENSING EXAMINATIONS/APPLICATION FOR LICENSE TO PRACTICE PSYCHOLOGY (App\#863-107 ) This application is for first-time applicants who meet the following criteria: 􀀻 Have received a doctoral degree from a program that is either accredited by the American Psychological Association (APA) or designated by the Association of State and Provincial Psychology Boards (ASPPB)/National Register Designation Project. 􀀻 Have completed supervised experience that began on or after December 6 , 2010. CHECKLIST: 1. 􀂆 Application to Request Approval to Sit for the Psychology Licensing Examinations/Application for License to Practice Psychology If any documentation submitted in connection with this application will be received in a name other than the name under which you are applying, you must submit a copy of the legal document(s) indicating the name change (i.e., marriage certificate, divorce decree which indicates the retaking of your maiden name; legal document indicating the retaking of a maiden name, or court order). 2. 􀂆 $105.00 Application Fee – Check or money order made payable to the Commonwealth of Pennsylvania. Fees are not refundable or transferable. If you do not receive the Board's approval to sit for the examinations within one year from the date your application is received, you will be required to submit another application fee. A processing fee of $20.00 will be charged for any check or money order returned unpaid by your bank, regardless of the reason for non-payment. 3. 􀂆 The Bureau of Professional and Occupational Affairs (BPOA), in conjunction with the Department of Human Services (DHS), is providing notice to all health-related licensees and funeral directors that are considered “mandatory reporters” under section 6311 of the Child Protective Services Law (CPSL) (23 P.S. § 6311), as amended, that EFFECTIVE JANUARY 1, 2015, all persons applying for issuance of an initial license shall be required to complete 3 hours of DHS-approved training in child abuse recognition and reporting requirements as a condition of licensure. Please review the Board website for further information on approved CE providers. Once you have completed a course, the approved provider will electronically submit your name, date of attendance, etc. , to the Board. Child Abuse Continuing Education Providers Information can be found here. 4. 􀂆 A Criminal Background Check from the state in which you reside must be submitted. The criminal background check must be completed within 90 days of submission of this application to the Board. Pennsylvania background checks may be obtained at [https://epatch.state.pa.us](https://epatch.state.pa.us or)[ or](https://epatch.state.pa.us or)[ ](https://epatch.state.pa.us or)[from the Pennsylvania State Police Central Repository](from the Pennsylvania State Police Central Repository), 1800 Elmerton Ave. , Harrisburg, PA 17110-9758,(717) 783-5593. (If you reside outside of Pennsylvania, you must contact the State Police from your jurisdiction.) 5. 􀂆 A Child Abuse History Clearance completed by the Pennsylvania Department of Human Services. The report must be dated within 90 days from the date this application is received in the Board office. The Pennsylvania Child Abuse History Clearance Form (CY 113) is available on the Department of Human Services web [site at](site at www.dhs.pa.gov. To check on)[ ](site at www.dhs.pa.gov. To check on)[www.dhs.pa.gov](site at www.dhs.pa.gov. To check on)[. To check on](site at www.dhs.pa.gov. To check on) the status of a request for the Child Abuse Clearance call 717-783-6211. 6. 􀂆 Provide a Self-Query from the

FAQs

Who is eligible to use this first-time psychology licensure application?

First-time applicants must meet the doctoral accreditation requirement (APA or ASPPB/NRDP designation) and have completed supervised experience that began on or after December 6, 2010.

What documents must be submitted as part of the checklist?

Submission includes an application form, application fee, and supporting materials such as name-change legal documents (if applicable), mandatory child-abuse training evidence, criminal background check, child abuse history clearance, NPDB self-query, and an official sealed doctoral transcript, plus accreditation/internship verification and other required authorizations.

What happens after the Board receives the items in the checklist?

After receipt of items 1–9, the Board determines eligibility to sit for the EPPP; if approved, information is sent to ASPPB for account activation. After item 10 is received, the Board determines whether the supervised experience requirement is met for the PPLE scheduling process via Professional Credentialing Services.

Sep 17, 2026

Uploaded by Logic