Healthy Communities

APB - Forms

Licensee Forms

Active Licensees:
Licensed Psychological Examiner - 395
Licensed Psychological Examiner - Independent Status - 267
Licensed Psychologist - 606

Licensees and Applicants - Utilize the links on the left-hand side of the page for forms related to your licensure status.

License Verification:

 

Psychologists Forms

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.

 

Licensed Psychological Examiner Independent Status Forms

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.

 

Licensed Psychological Examiner Forms

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.

 

Provisional Licensees Forms

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.

 

Technicians Forms

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.

 

New Applicants

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.

 

Mobility Programs & Forms

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.

Application Packets Available:

 

Voluntary Inactive/Retired Licensees

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.

 

Mailing List

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.

We accept credit card payments.  Payment information is included on the form.

Charge: $100.00 for a mailing list of active licensed Psychologists and Psychological Examiners in Arkansas.

The mailing list will be in Excel and will consist of the following for active and voluntary inactive licensees:

License Type Address
Abbreviation City
License Number State
Highest Degree Zip
Title Work Phone
First Name E-Mail
Middle Name License Began
Last Name License Expires

Public Health Accrediation Board
Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved. www.healthy.arkansas.gov
4815 W. Markham, Little Rock, AR 72205-3867
1-800-462-0599