Psychologist Application for Licensure by Examination Clinical Psychologist School Psychologist Applied Psychologist Check one: Military/Military Spouse: Are you active duty military personnel? No □ Yes □ Are you the spouse of a member of the U.S. military who has been transferred to Virginia and who had to leave employment to accompany your spouse to Virginia? Yes No □ □ Complete All Sections Application Fee of $200.00 is Non-Refundable Application forms lacking a Social Security or VA DMV number will not be processed. Mail all required documentation and fee to: Board of Psychology ., , Henrico, 23233 All signatures must be original. Education/Training (List in chronological order all graduate schools attended. Include transcripts.) * The address provided in this section is subject to disclosure under the Freedom of Information Act.
Psychologist Application for Licensure by Examination Check one: Clinical Psychologist School Psychologist Applied Psychologist Military/Military Spouse: Are you active duty military personnel? □ Yes □ No Are you the spouse of a member of the U.S. military who has been transferred to Virginia and who had to leave employment to accompany your spouse to Virginia? □ Yes □ No Complete All Sections Application Fee of $200.00 is Non-Refundable Application forms lacking a Social Security or VA DMV number will not be processed. Mail all required documentation and fee to: Board of Psychology ., , Henrico, 23233 All signatures must be original. Education/Training (List in chronological order all graduate schools attended. Include transcripts.) * The address provided in this section is subject to disclosure under the Freedom of Information Act.
Exam_application.docx