License Renewal Form
The 2017 - 2018 printable License Renewal Form.
Renewal can be done online through your profile. Login
Application for Licensure
IMPORTANT NOTE: Mississippi requires an APA accredited Doctoral training program OR an emerging program which will submit documentation that it is seeking APA accreditation.
Continuing Education Reporting Form
Download a copy of the CE reporting form used to report your CE activities for the biennial reporting period or report Continuing Education online through your profile, login here.
Application for Licensure by CPQ
IMPORTANT NOTE: Mississippi participates in an ASPPB CPQ agreement.
The Certificate of Professional Qualification in Psychology (CPQ) is a program by the Association of State and Provincial Psychology Boards (ASPPB) to promote mobility for licensed doctoral psychologists in the United States and Canada. The CPQ documents that the individual holding the certificate has met specific requirements in licensure, education, examination and training and has never had disciplinary actions taken against his or her license.
Application can also be submitted online
Application for Temporary Practice Certificate
Application for Temporary Practice Certificate may be submitted online. If you have never had a Temporary Practice Certificate go here. If you have had a Temporary Practice Certificate in the past login to your profile and and submit a new request.
The Temporary Practice Certificate is designed for psychologists already licensed in another jurisdiction who have a limited or temporary need to provide services in Mississippi, which would otherwise require a permanent Mississippi license. For example, a forensic psychologist may plan to provide services as part of a criminal or civil case. It is not designed for those in the process of obtaining a Mississippi license, or those who have had a Mississippi license denied or revoked. Approval requires verification of current license in another jurisdiction, passing a brief written examination on psychology licensure in Mississippi, and payment of the required fee.
Interjurisdictional Practice Certificate (IPC)
IMPORTANT NOTE: Mississippi participates in an ASPPB IPC agreement.
The Interjurisdictional Practice Certificate (IPC) is a mechanism for licensed psychologists to more easily practice temporarily in another jurisdiction. The IPC will provide ASPPB member jurisdictions with better oversight and regulation of licensed psychologists wishing to practice temporarily in their state, province or territory. The concept behind the IPC is one of “notification” and “temporary permission to practice” rather than full licensure.
Substantial and significant change in Scope of Practice - Reporting Form
If you wish to apprise the Board of significant and substantial changes in your scope of practice since your oral exam when you deliniated your specific competencies, please complete this "Modifying Scope of Practice" form.
Name Change Form
Use this form to request a change of your name.
Address Change Form
Use this form to request a change of your address. Address changes can also be made online through your profile. Login
Duplicate Card or Certificate Form
Use this form to request a duplicate certificate or card. You can also order, pay and print the certificate online through your profile. Login
Mailing List Purchase Form
Request for Investigation
This form should be filled out in detail, notarized, and accompanied by a release of information form in order for the Board to begin action on a complaint. Complaints must be made in writing and notarized. The Board will take no action on complaints made by telephone, e-mail or other means. Visit the Online Complaint Form here.
Request for License Verification
Use this form to request an official verification of licensure or Request for License Verification online.