64B19-11.012. Application Forms  


Effective on Monday, August 22, 2022
  • 1(1) All applicants for licensure pursuant to Chapter 490, F.S., shall complete and submit form DH-MQA 1187, (revised 04/22), “Application for Licensure as a Psychologist,” which is incorporated herein by reference and which may be obtained from 39http://www.flrules.org/Gateway/reference.asp?No=Ref-14597, 41the Board office, or at http://floridaspsychology.gov/applications/psychology-licensure-app.pdf.

    47(2) An applicant who is a diplomate in good standing with the American Board of Professional Psychology, Inc., and who wishes to apply for licensure by endorsement pursuant to Section 77490.006(1)(a), F.S., 79shall submit as part of his or her application PY FORM 4.abpp (rev. 07/21), “ABPP Diplomate Verification Form,” which is incorporated herein by reference and which may be obtained from 110http://www.flrules.org/Gateway/reference.asp?No=Ref-13615, 112the Board office, or at https://floridapsychology.gov/applications/abpp-diploma-verification-form.pdf.

    118Rulemaking Authority 120456.013, 121456.025, 122490.004(4), 123490.005 FS. 125Law Implemented 127456.013, 128456.025, 129456.0635, 130490.005, 131490.006 FS. 133History–New 6-25-02, Amended 5-24-09, 3-1-10, 5-23-10, 11-10-11, 6-18-12, 12-25-12, 10-28-13, 5-1-14, 11-2-14, 4-6-15, 12-3-15, 4-21-16, 9-27-16, 11-23-17, 2-18-19, 3-28-21, 6-21-21, 10-19-21, 8-22-22155.

     

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