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The official website of the State of Mississippi

Forms

Continuing Education Reporting Form
Report Continuing Education hours online through your profile. Login here.

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, please complete the "Adding Areas of Competence" form.

Name Change Form
Use this form to request a change of your name.

Duplicate Certificate Request​
You may print your certificate online through your profile. Login

Mailing List Purchase Form
Use this form to purchase the mailing list. Contact the Board office for more information. 
If you want to mail a check use the paper form. To pay electronically​ use the online form

Request for License Verification​
Use this form to request an official verification of licensure or Request for License Verification online.​

How to File a Complaint with the Board
Download a "Request for Investigation" form for use. 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 complaints. Complaints must be in writing and notarized. The Board will take no action on complaints made by telephone, e-mail or other means.