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Virginia Administrative Code
Title 18. Professional And Occupational Licensing
Agency 125. Board of Psychology
Chapter 20. Regulations Governing the Practice of Psychology
12/24/2025

FORMS (18VAC125-20).

Initial Licensure by Examination for Clinical Psychology (rev. 10/2024)

Licensure by Endorsement for Clinical Psychology (rev. 10/2024)

Initial Licensure by Examination for School Psychology (rev. 10/2024)

Licensure by Endorsement for School Psychology (rev. 10/2024)

Initial Licensure by Examination for Applied Psychology (rev. 10/2024)

Licensure by Endorsement for Applied Psychology (rev. 10/2024)

Initial Licensure for School Psychologist-Limited (rev. 10/2024)

Initial Licensure by Examination for Psychological Practitioner (rev. 9/2025)

Initial Licensure by Examination for Autonomous Psychological Practitioner (rev. 9/2025)

Verification of Post-Degree Supervision for Psychological Practitioner Autonomous Practice (rev. 9/2025)

Change of Status Request Active to Inactive (rev. 8/2024)

Change of Status Request Inactive to Active at Renewal (rev. 8/2024)

Change of Status Request Inactive to Active (rev. 8/2024)

Reinstatement Application for Clinical, School, Applied, and Psychological Practitioner (rev. 10/2025)

Reinstatement Following Disciplinary Action for Clinical, School, and Applied (rev. 10/2024)

Reinstatement for School Psychology-Limited (rev. 10/2024)

School Psychologist-Limited Employment Verification (rev. 8/2024)

Initial Registration of Residency for Clinical Psychology (rev. 10/2024)

Add/Change Residency for Clinical Psychology (rev. 10/2024)

Termination of Supervision Form - Clinical Psychology (rev. 8/2024)

Resident in Clinical Psychology Supervisor Contract (rev. 9/2023)

Initial Registration of Residency for School Psychology (rev. 10/2024)

Add/Change Residency for School Psychology (rev. 10/2024)

Termination of Supervision - Resident in School Psychology (rev. 8/2024)

Resident in School Psychology Supervisor Contract (rev. 8/2023)

Verification of Post-Degree Supervision for Clinical Psychology (rev. 8/2024)

Internship Equivalency Form (rev. 3/2025)

Verification of Active Practice - Clinical Psychology (rev. 8/2024)

Verification of Internship - Clinical Psychology (rev. 8/2024)

Verification of Pre-Doctoral Supervised Practicum Hours - Clinical Psychology (rev. 8/2024)

Verification of Post-Degree Supervision for School Psychology (rev. 8/2024)

Verification of Internship - School Psychology (rev. 8/2024)

Verification of Post-Licensure Active Practice - School Psychology (rev. 8/2024)

Areas of Graduate Study - Verification of Required Coursework for Clinical Psychologists (rev. 8/2024)

Areas of Graduate Study - Verification of Required Coursework for School Psychologists (rev. 8/2023)

Areas of Graduate Study - Verification of Required Coursework for Applied Psychologists (rev. 8/2024)

Areas of Graduate Study - Verification of Required Coursework for Psychological Practitioners (rev. 9/2025)

Continuing Education Summary Form (rev. 11/2025)

Request for Virginia Licensure Verification (rev. 8/2024)

Supervisor Out-of-State Verification Form (rev. 8/2024)

Verification of Active Practice for Applied Psychologists (rev. 8/2024)

Request for Board Approval of Practice Supervisor (rev. 9/2024)

Authorization to Disclose for Practice Supervisor (rev. 11/2025)

Practice Supervisor Report (rev. 9/2024)

Initial Therapy Report for Compliance (rev. 9/2024)

Therapy Quarterly Report for Compliance (rev. 9/2024)

Licensee Self Report (rev. 9/2024)

Request for Board Approval of Therapist (rev. 9/2024)

Group Attendance Log (rev. 9/2024)

Prescription Report (rev. 9/2024)

Initial Contact Form for Compliance (rev. 9/2024)

Employer Notification of Board Order (rev. 9/2024)

Name or Address Change Form (rev. 8/2024)

Continuing Education or Course Approval Request for Compliance Monitoring (rev. 9/2024)

Request for Board Approval of Evaluator (rev. 9/2024)

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

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