Forms_Page_LPE-I

Forms - LPE-I

These are forms for Psychological Examiners with Independent Practice.

Licensed: 
(please click a button)

Psychological Examiner
Licensed Before 1997

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If you are a fully-licensed Psychological Examiner, and you were licensed before 1997, you can complete the Statement of Intent Pre-1997 form.  Please also include a cover letter requesting independent practice.

The Statement of Intent Pre-1997 form must match with the current Statement of Intent on file.  You may request a copy of your current Statement of Intent by contacting the Board office.

If you would like to change your Statement of Intent on file, you must complete a Statement of Intent (non-Independent Practice) form, found here.  This form must be Board approved.   Then, you can complete a Statement of Intent Pre-1997 to match with the most recent Statement of Intent on file.

   (Word)

Psychological Examiner
Licensed 1997 and After

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If you are a fully-licensed Psychological Examiner, and you were licensed in 1997 or after, you can complete the Statement of Intent Post-1997 form and the LPEI Supervision Plan.  Please also include a cover letter requesting independent practice.

The LPEI Supervision Completion form will be submitted when you have met the requirements of the Post-1997 LPEI status.

The Statement of Intent Post-1997 form must match with the current Statement of Intent on file.  You may request a copy of your current Statement of Intent by contacting the Board office.

If you would like to change your Statement of Intent on file, you must complete a Statement of Intent (non-Independent Practice) form, found here.  This form must be Board approved.   Then, you can complete a Statement of Intent Post-1997 to match with the most recent Statement of Intent on file.

   (Word)

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Arkansas Psychology Board 
101 East Capitol, Suite 415
Little Rock, AR  72201
Telephone: (501) 682-6167
Fax: (501) 682-6165

   www.arkansas.gov/abep
   APBinfo@arkansas.gov