Child Abuse - ✔✔recent act or failure to act that causes nonaccidental (or imminent risk of) physical
injury, mental injury, sexual abuse, or sexual exploitation to a child under 18 years of age.
serious physical neglect constituting prolonged or repeated lack of supervision or the failure to provide
the essentials of life (includes adequate medical care) which endangers a child's life or development or
impairs functioning.
Delegated Supervisor - ✔✔provides up to 1 of the 2 hours of required weekly supervision and holds a
current license, certificate, or registration from a health related board or someone who is exempt from
licensure.
Individual residing in the same home as the child - ✔✔14 years of age or older
Professional Relationship - ✔✔beginning with the first professional contact or consultation between a
psychologist and a client/patient and continuing through the date of the last professional service.
if contact is on an intermittent basis, the relationship shall be deemed to state anew on each date seen.
Recent Acts or Omissions - ✔✔acts or omissions within 2 years of the date of the report to the Dept of
Public Welfare or county agency.
Serious Mental Injury - ✔✔psychological condition diagnosed by a physician or licensed psychologist
that does 1 or more of the following:
a. renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic, or
in reasonable fear that the child's life or safety is threatened.
b. seriously interferes with the child's ability to accomplish age-appropriate developmental and social
tasks.
,Serious Physical Injury - ✔✔injury that causes a child severe pain or significantly impairs a child's
physical functioning (temporarily or permanently).
Licensee's Change of Address/Name - ✔✔the change shall be reported to the board in writing within 10
days
Recognized Professions - ✔✔these groups may do work of a psychological nature, consistent with the
training and the code of ethics of their respective professions:
activity and focus of the group is based on an identifiable body of theoretical knowledge
knowledge is demonstrably different than psychology
regulate entrance into professional membership through standards of knowledge, training, and
proficiency
activity must be guided by generally accepted quality standards, ethical principles, and requirements for
independent profession
Substance Abuse - ✔✔the board's licensing and regulatory authority extends to psychology practices
that provide services to clients/patients with substance abuse problems.
License Exam Application - ✔✔application form
application fee
transcripts from accredited university
criminal history record (within 90 days of app)
child abuse history (within 90 days of app)
internship verification form
job description
, License Expiration Date - ✔✔November 30th of each odd numbered year
License Renewal Date - ✔✔renewable for 2 year period
December 1st of each odd numbered year
License Duplication - ✔✔issued after submission of a notarized statement that the original was lost or
destroyed & duplicate will be returned if original is recovered
Application Fee - ✔✔original fee: 105
reapplication fee (1st time fail): 20
second time fail: 90
certification fee: 25
verification fee: 15
biennial renewal fee: 300
app fee continuing ed sponsor: 165
fictitious name registration: 80
License Reactivation - ✔✔in the case of lapse/inactive license:
apply
pay renewal fee
show continuing education requirements
submit notarized affidavit indicating dates during which the psychologist did not practice psychology
Professional Corporations - ✔✔identify all parties with ownership interest & all licensed/unlicensed staff
name of corporation must be approved
if the corporation targets a specific area of psychology (neuro/clinical/biofeedback) must submit
documentation of sufficient training to establish credentials in that field
Fictitious Names - ✔✔may do business under a fictitious name
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