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Downtown Newark, NJ

State Board of Psychological Examiners

Applications and Forms


Unless specifically directed to do so by Board/Committee staff, do not mail your application and/or request to the Board/Committee office. 

Initial Applications

One-Year Permit, Three-Year Permits, Licensed Psychologist Application

  1. Register on our website and submit your application online
  2. All third party documents including official transcripts, license/certificate verifications are to be emailed to PsychologyApplications@dca.njoag.gov
  3. Inquiries about the application process can be sent to PsychologicalExaminers@dca.njoag.gov

Miscellaneous Application Forms

  1. Fill out (or have the appropriate party fill out)  the required form, links below:
    1. Certificate of Good Moral Character
    2. Supervisory Form for Psychology Candidates
    3. Application for Proposed Supervisors (There is a $50.00 fee per additional supervisor).
  2. Upload completed form and any supporting documents to your online profile through the Upload License Documents tab.
  3. If there is a fee associated with your application you will be emailed an invoice with instructions to pay the outstanding fee.
  4. All subsequent inquiries should be sent to PsychologicalExaminers@dca.njoag.gov

Name Change Request

  1. Write a letter which must include the following information:
    1. current name;
    2. new name; and
    3. whether you are also requesting a duplicate license be printed with new name.
  2. Scan letter and all supporting documents (marriage license, divorce decree, or court order) to your online profile through the Upload License Documents tab.
  3. If requesting a duplicate license you will be emailed an invoice for $25 and instructions to pay.
  4. Follow up inquiries may be sent to psychologicalexaminers@dca.njoag.gov

License Verification Requests

  1. Reach out to the requesting board/jurisdiction and obtain an email address to where we can send electronic verification. We can only provide electronic verification at the time.
  2. Formulate your written/signed request for an out-of-state verification.
  3. Your request must include:
    1. your New Jersey license/certificate number;
    2. your mailing address;
    3. your e-mail address; and
    4. the e-mail address where verification is to be sent.
  4. If the other state requires completion of a specific form, complete the part of the form pertaining to "Applicants" before submitting it for the Board's completion.
  5. Upload your request and any document that you may require us to fill out for verification to your online profile through the Upload License Documents tab.
  6. Once the request is processed, you will be sent an email with an invoice and instructions for payment. The fee for each request is $35.
  7. Incomplete requests will delay the processing of the verification.
  8. All subsequent inquiries should be sent to PsychologicalExaminers@dca.njoag.gov.

Duplicate License Request

  1. Write a letter which must include the following information:
    1. your name;
    2. license number;
    3. address of record;
    4. mailing address; and
    5. reason for requesting duplicate license (lost, stolen, never received).
  2. Upload completed form to your online profile through the Upload License Documents tab.
  3. You will be emailed an invoice for $25 and instructions for payment.
  4. All subsequent inquiries should be sent to PsychologicalExaminers@dca.njoag.gov.

Applications for Reinstatement/Reactivation

  1. Send an email to PsychologicalExaminers@dca.njoag.gov and in the subject line type Reinstatement/Reactivation Application Request.
  2. Once the reinstatement application is sent to you, fill out and upload the application and any supporting documentation to your online profile through the Upload License Documents tab.
  3. Upon receipt, you will be emailed the appropriate invoices for the outstanding fees. Please visit our regulations to view the fees for reactivation/reinstatements.
  4. All subsequent inquiries should be sent to PsychologicalExaminers@dca.njoag.gov.

To Check the Status of Your Application

  1. Log into your online profile.
  2. On the application type you wish to see click on View Checklist.
  3. Items that do not have a complete date next to them are still missing.
  4. You may upload missing items to your online profile through the Upload License Documents tab except for third party documents (transcripts, license verifications) which should be received directly by the Board from those entities and are to be emailed to PsychologyApplications@dca.njoag.gov.
  5. Inquiries about the status of your application can be sent to PsychologicalExaminers@dca.njoag.gov.




Last Modified: 3/15/2021 1:23 PM