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Provisional Licensees Forms

Note: Forms must include a cover letter with each submission. Incomplete submissions will not be processed by the Board nor will the incomplete submission be returned to you.

Board Meeting Agenda Items
If you would like to have an item on the Board meeting agenda, it must be in the office by the 1st of the month. The request must be submitted in writing and mailed to the Board office. Facsimiles and e-mails will not be accepted.

This includes applications for credential reviews. The application must be complete and ready for review by the 1st of the month to be considered at the Board meeting.

Please plan accordingly!

Title Type
Provisional License Payment Form PDF
Provisional License Supervision Log PDF
Psychologist Postdoctoral Supervision Form PDF
Statement of Intent Provisionally Licensed Examiner PDF
Statement of Intent Provisionally Licensed Psychologist PDF
Supervision Agreement and Plan PDF
Supervision Report Form PDF

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Arkansas Psychology Board
101 East Capitol, Suite 415
Little Rock, AR 72201
(501) 682-6167
Fax: (501) 682-6165
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