School Psychologist Registration

Name *

First

Middle

Last

Gender

Male
Female

Email *

Phone

Residential Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

District

Are you a Nationally Certified School Psychologist?

Notes:

Have you ever been denied a professional license license or certificate or disciplined in any way (i.e. denied, suspended, reprimanded, censured, restricted, limited, placed on probation, revoked, etc.) by any entity?

Have you ever been convicted of, or entered a plea of guilty or nolo contendere to any felony or misdemeanor other than a minor traffic violation?

How long have you been working as a school psychologist?

Upload Documents *

Drag & Drop Files, Choose Files to Upload You can upload up to 6 files.

Upload your Affidavit, Verification of Licensure, Authorization for Release of Information, Verification of completion of internship, Attestation of Experience by Supervisor, and Government Issued Photo ID

Signature

Clear Signature

Printed Name

Date

Single Item

Price: $175.00

SCHOOL PSYCHOLOGIST REGISTRATION

USVI Board of
Psychology Examiners

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