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Terms in this set (65)
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 Abuse 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.
provides up to 1 of the 2 hours of required weekly
Delegated Supervisor 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 14 years of age or older
home as the child
beginning with the first professional contact or consultation
between a psychologist and a client/patient and continuing
Professional Relationship 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.
acts or omissions within 2 years of the date of the report to
Recent Acts or Omissions
the Dept of Public Welfare or county agency.
, 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,
Serious Mental Injury 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withdrawn, psychotic, or in reasonable fear that the child's life or safety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.
injury that causes a child severe pain or significantly impairs a
Serious Physical Injury
child's physical functioning (temporarily or permanently).
Licensee's Change of the change shall be reported to the board in writing within 10 days
Address/Name
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
Recognized Professions
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
the board's licensing and regulatory authority extends to
Substance Abuse
psychology practices that provide services to clients/patients
with substance abuse problems.
application
form
application
License Exam 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
renewable for 2 year period
License Renewal Date
December 1st of each odd numbered year
issued after submission of a notarized statement that the
License Duplication
original was lost or destroyed & duplicate will be returned if
original is recovered
original fee: 105
reapplication fee (1st time fail):
20 second time fail: 90
certification fee: 25
Application Fee verification fee: 15
biennial renewal fee: 300
app fee continuing ed
sponsor: 165 fictitious name
registration: 80
, in the case of lapse/inactive license:
apply
pay renewal fee
License Reactivation
show continuing education requirements
submit notarized affidavit indicating dates during which the
psychologist did not practice psychology
identify all parties with ownership interest & all
licensed/unlicensed staff name of corporation must be
Professional Corporations
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
may do business under a fictitious name
Fictitious Names
must be filed with the board for review/approval
educational
Licensure Qualifications requirements
experience
requirements
examination
requirements
sealed envelope signed by
supervisior post doc
experience form
Application for Licensure
quarterly evals with objectives
letter of judgment from supervisor
updated criminal history record form
(within 90 days) updated child abuse
clearance (within 90 days)
complete the requirements for a doctoral degree in psychology or a
related field
USA/Canada applicants: verification of doctoral program
approval status completed by the program director regarding
accreditation and within 1 year of the award of the degree,
official transcript from registrar
Educational Requirements foreign college: evaluation completed by the National
Register to evaluate compliance with educational
requirements for degree holders