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Kentucky Board of Examiners of Psychology

Board of Examiners of Psychology
Applications and Forms

Adobe Required
Note: The documents on this page are in Adobe Acrobat (PDF) format. Please click on the following link to download a free copy of Adobe Acrobat Reader.

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Online Supervision Announcement

The Board has transitioned to an online supervision documentation system. Most forms that were previously completed on paper are now entered directly into your eServices account; therefore, these forms have been removed from this page and will not be made available to submit. This includes the Supervisory Plans and Goals, Supervisory Report, and Request for Change in Supervisor and/or Frequency.​​​ 

The only exception is new applicants who must complete the supervision documents via paper. This form can be accessed below via the Initial Licensure Supervision Documents link.​

For guidance on submitting supervision documents through eServices, please see the Supervision Manual below.


 

 Forms Library

 
  
  
  
  
Application for Licensure as a Psychological Associate.pdf
  
523 KB 3/24/2020 3:30 PM
Application for Licensure as a Psychological Practitioner.pdf
  
486 KB 3/24/2020 3:30 PM
Application for Licensure as a Psychologist by Reciprocity.pdf
  
436 KB 3/24/2020 3:28 PM
Application for Licensure as a Psychologist.pdf
  
541 KB 3/24/2020 3:28 PM
Application for Licensure of a Psychologist Licensed in Another State.pdf
  
435 KB 3/24/2020 3:29 PM
Continuing Education Program Application.pdf
  
307 KB 3/24/2020 3:26 PM
Continuing Education Sponsorship Application.pdf
  
531 KB 3/24/2020 3:27 PM
Form to File a Complaint.pdf
  
129 KB 3/24/2020 3:44 PM
Initial Licensure Supervision Documents.pdf
  
370 KB 10/24/2019 2:38 PM
Nonresident Psychologist Registration Form.pdf
  
201 KB 3/24/2020 3:32 PM
Open Records Request.pdf
  
175 KB 3/24/2020 3:46 PM
Recommendation for Licensure as a Psychological Practitioner.pdf
  
364 KB 3/24/2020 3:30 PM
Recommendation Form for Licensure as a Psychological Associate.pdf
  
297 KB 3/24/2020 3:30 PM
Recommendation Form for Licensure as a Psychologist.pdf
  
297 KB 3/24/2020 3:29 PM
Request for Change of License Status.pdf
  
315 KB 3/24/2020 3:32 PM
Request for Extension of Temporary Licensure as a Psychological Associate.pdf
  
299 KB 3/24/2020 3:30 PM
Request for Extension of Temporary Licensure as a Psychologist.pdf
  
299 KB 3/24/2020 3:29 PM
Request for Mailing List.pdf
  
223 KB 3/24/2020 3:46 PM
Special Application.pdf
  
329 KB 3/24/2020 3:33 PM
Supervision Manual.pdf
  
7016 KB 4/2/2020 10:31 AM
Supervisor Recommendation for Licensure as a Psychological Practitioner.pdf
  
383 KB 3/24/2020 3:31 PM