New Hampshire Code of Administrative Rules
Psyc - Board of Psychologists
Chapter Psyc 300 - LICENSE AND REGISTRATION REQUIREMENTS, APPLICATIONS AND FEES
Part Psyc 303 - APPLICATION PROCESS
Section Psyc 303.02 - Application Process
Universal Citation: NH Admin Rules Psyc 303.02
Current through Register No. 13, March 27, 2025
(a) Persons wishing to obtain licensure as a psychologist in New Hampshire shall apply to the OPLC by submitting the following:
(1) A "Universal
Application for Initial Licensure" as described in (d) below, and "Addendum to
the Universal Application For Initial Licensure" as described in (c)
below;
(2) Supporting documents
required of the applicant, as specified in (e) below;
(3) The results of the examination for the
professional practice of psychology (EPPP) taken in accordance with Psyc
303.05(b) and submit directly to the OPLC; and
(4) Any fees in accordance with Plc 1002.43
and Plc 1001.08.
(b) Applicant's shall complete and submit the "Universal Application for Initial Licensure" pursuant to Plc 304.03" to the OPLC.
(c) In addition to the application required by (a) above, the applicant shall complete and submit the "Addendum to the Initial Application Required by Plc 304.03" by providing the following:
(1) All names the applicant has ever been
known by; and
(2) An answer to the
question "In the event of your impairment or death do you have a plan in place
for the security of records and the patient accessibility of those records
including timeframes for which those records should be kept?".
(d) The applicant for initial licensure shall sign and date the application in accordance with Plc 304.05.
(e) Applicants applying for their initial license shall provide the following supporting documentation in addition to the initial application for licensure as a psychologist described in Psyc 303.02(b):
(1) A "Summary of
Supervised Clinical Experience for Internship and Post Doc" form, in which the
applicant shall report and submit with the initial applicant for licensure as a
psychologist:
a. The applicant's legal
name;
b. The applicant's home
mailing address;
c. The start and
end date of post graduate supervision;
d. The name of the facility where clinical
work was performed;
e. The name of
the supervisor;
f. The total hours
of face-to-face on-site individual and group supervision received;
g. The total hours of clinical experience
obtained for each of the following:
1.
Predoctoral internship experience of a minimum of 1500 hours; and
2. Postdoctoral experience of a minimum of
1500 hours;
h. The date
of conferral of the doctoral degree;
i. The total hours of supervised clinical
experience; and
j. The applicant's
signature and date of signing below the following attestation:
"I certify that the above information is correct to the best of my knowledge and belief.";
(2) A "Graduate Program Course Sheet" on
which the applicant shall provide and submit with the initial application for
licensure as a psychologist the following information:
a. Answering yes or no to the question: "Was
any part of your graduate study online, telephonic, or other remote
learning?";
b. Attaching to the
"Graduate Program Course Sheet" documentation that the requirements of Psyc
302.02(b), (c), and (d) were met if the answer to the question in a. above was
yes;
c. Answering yes or no to the
question on whether the graduate program is APA or CPA approved;
d. Attaching to the "Graduate Program Course
Sheet", a one-page verification from the applicant's program's materials, a
letter from the program which confirms the status, or a copy from the APA or
CPA website page showing accreditation of the program while the applicant was
in attendance if the program was accredited;
e. If a graduate program is not APA or CPA
accredited attach a separate sheet to the "Graduate Program Course Sheet", and
list the course titles and number of credits earned for each of the following
if the answer to question in d. above was no:
1. Scientific and professional ethics and
standards;
2. Research design and
methodology;
3.
Statistics;
4.
Psychometrics;
5. Psychotherapy
techniques;
6. Biological and
chemical bases of behavior, including physiological psychology, comparative
psychology, neuropsychology, sensation and perception, and
psychopharmacology;
7.
Cognitive-affective bases of behavior, including learning, thinking,
motivation, and emotion;
8. Social
bases of behavior, including social psychology, group processes, organization
and systems theory, and cultural diversity; and
9. Individual differences, including
personality theory, human development, and abnormal psychology; and
f. The total credits
earned;
(3) An
"Internship Confirmation Form", completed by the applicant and forwarded to the
supervisor of the internship experience authorizing the internship program to
release all information in their records regarding the applicant to the
OPLC;
(4) The "Internship
Conformation Form" shall require:
a. The
applicants for licensure to provide the following information:
1. The applicant's legal name;
2. The applicant's home mailing
address;
3. The applicant's home or
cell phone number;
4. The
applicant's signature and date of signing below the following authorization:
"I am applying for a license as a psychologist in New Hampshire. The New Hampshire Board of Psychologists requires confirmation of internship supervised clinical experience. This shall serve as your authorization to release any information you have in your files whether favorable or not.";
b. The director of the internship experience
to provide the following information:
1. The
name of the internship program;
2.
The name of the facility;
3. The
physical address of the facility;
4. Answer yes or no to the question on
whether the program was APA approved at the time the applicant
attended;
5. If the answer to iv.
above is no, attach a description of the pre doctoral requirements described in
Psyc 302.04;
6. Number of interns
in training at the same time as the applicant;
7. The applicant's title in the
program;
8. The start date and end
date the applicant was in the program;
9. Whether the hours of internship experience
were full time or part time and the number of hours worked per week;
10. The hours of face-to-face supervision per
week;
11. Total supervised
face-to-face hours in the time period described in ix. above including
individual and group supervision;
12. The number of hours worked per week, the
number of weeks worked, and the total number of completed hours
worked;
13. The name of the primary
supervisor, together with the person's degree status, state licensing status
and state license number;
14.
Answer yes or no to the question was the internship successfully
completed;
15. If the answer to ix.
above was no, attach a detailed explanation to the form;
16. Whether the supervisor will recommend
licensure without reservation, with reservation, or against license;
17. If the supervisor indicates that their
recommendation in xvi. above is with reservation or against licensure attach a
detailed explanation;
18. The name
of the director;
19. The title of
the director at the time of the applicant's attendance at the internship
program;
20. The director's
academic degree;
21. The address of
the director;
22. The director's
telephone number and e-mail address of the program;
23. The director's state of licensure and
license number; and
24. The
director's or supervisor's signature and date of signing below the following
attestation:
"I hereby attest that all of the information contained on the form is true and accurate to the best of my knowledge and belief.";
(4) A
completed and signed "Postdoctoral Experience Form" that includes the
following:
a. In the section to be completed
by the applicant the following:
1. The
applicant's name;
2. The
applicant's phone number;
3. The
applicant's home mailing address; and
4. The applicant's signature and dated of
signing below the following authorization:
"I am applying for a License as a Psychologist in New Hampshire. The New Hampshire Board of Psychologists requires confirmation of postdoctoral supervised clinical experience. This is your authority to release any information you have in your files, favorable or otherwise."; and
b. The following is to
be completed by the supervisor of postdoctoral experience:
1. The name of the post-doctoral program, if
applicable;
2. The name of the
facility;
3. The address of the
facility;
4. Answer yes or no to
the question on whether the program APA approved at the time of the applicant's
attendance;
5. The applicant's
title in the program;
6. The start
and end date the applicant was in the postdoctoral program;
7. Whether the applicant's experience was
full time or part-time including the hours per week for each;
8. The hours of face-to-face supervision per
week and the total during the entire program;
9. The name of the primary supervisor
including degree, state license or certificate held, and license or certificate
number;
10. Answer yes or no to the
question on whether the applicant's post-doctoral experience successfully
completed;
11. Whether the
reference will recommend licensure without reservation, with reservation, or
against license;
12. If the
director indicates that their recommendation in xi. above is with reservation
or against licensure attach a detailed explanation;
13. The name of the supervisor;
14. The supervisor's title at the time of the
program;
15. The supervisor's
degree;
16. The address of the
program;
17. The telephone number
and e-mail address of the program;
18. The supervisor's state of licensure and
license number;
19. The
supervisor's license or certified field of specialty and issue date;
and
20. A signature and date of
signing below the following attestation:
"I hereby attest that all of the information contained on the form is true and accurate to the best of my knowledge and belief.";
(5) A
completed "Supervisor's Confirmation of Post Doctoral Clinical Experience" form
that includes the following:
a. In the
section to be completed by the applicant the following:
1. The applicant's legal name;
2. The applicant's home mailing address;
and
3. The applicant's signature
and date of signing below the following authorization:
"I am applying for a License as a Psychologist in New Hampshire. The New Hampshire Board of Psychologists requires confirmation of postdoctoral supervised clinical experience. This is your authority to release any information you have in your files, favorable or otherwise."; and
b. In the section to be
completed by the supervisor the following:
1.
The name of the facility where the supervision was provided;
2. The address of the facility;
3. The applicant's title at time of
supervision;
4. The start and end
dates of the supervised clinical experience;
5. The number of hours worked per week, the
number of weeks worked, and the total number of completed hours
worked;
6. Hours per week of
individual face-to-face supervision;
7. The total hours in time period;
8. The total supervised face-to-face hours in
time period in vi. above in including both individual and group
supervision;
9. Attach a detailed
description of the supervisory methods used, and the types of issues dealt with
during supervision including the names and credentials of clinical supervisors
other than the supervisor completing the application, if other supervisors are
included in the hours documented;
10. Attach a detailed description of the type
of work performed by the applicant;
11. Attach a detailed description of the
quality of work performed by the applicant;
12. Whether the reference will recommend
licensure without reservation, with reservation, or against license:
13. If the supervisor indicates that their
recommendation in vii. above is with reservation or against licensure attach a
detailed explanation;
14. The
supervisor's name;
15. The
supervisor's title at the time of supervision;
16. The supervisor's academic
degree;
17. The supervisor's
address;
18. The supervisor's phone
number;
19. The supervisor's e-mail
address;
20. The supervisor's state
of licensure and license number;
21. The supervisor's license or certification
field of specialty and date of issuance; and
22. The supervisor's signature and date of
signing below the following attestation:
"I hereby attest that all of the information contained on the form is true and accurate to the best of my knowledge and belief."; and
(6) Three
complete separate and distinct "Professional Reference Forms", which shall be
submitted in sealed untampered envelopes and one of which shall be completed by
a supervisor. All 3 forms shall:
a. Be signed
by a person providing a reference;
b. Contain the applicant's printed name and
address;
c. Be signed and dated by
the applicant, providing a release to the reference to release all pertinent
information concerning the applicant to the OPLC;
d. Contain the name, address, phone number,
title, degree, and signature of the reference;
e. Indicate the professional relationship to
the applicant, including the licensed status and license number of the
reference;
f. Indicate the length
of time the reference has known the applicant;
g. Describe the reference's knowledge of the
applicant's professional and ethical behavior;
h. Include the name of the organization and
title of the applicant's position when the reference worked with the
applicant;
i. Describe the
applicant's duties and responsibilities;
j. Indicate any area where the applicant has
a specialty;
k. Indicate whether
the reference will attest and certify that the applicant is of good moral
character, as defined in Psyc 303.01, and if not, the reasons supporting that
conclusion;
l. Explain the
circumstances, if applicable, surrounding any of the following of which the
reference is aware:
1. Whether the applicant
has been or is the subject of any malpractice or civil suit involving the
practice of their profession;
2.
Whether the applicant has been convicted of a crime in any state or country,
the disposition of which was other than acquittal or dismissal;
3. Whether there have been or are any
complaints or charges of violation of the ethical codes, professional
misconduct, unprofessional conduct, incompetence, or negligence made or pending
against the applicant;
4. Whether
the applicant has ever been required to surrender their license or
certification; and
5. Whether the
applicant has been found guilty of, or has entered into a consent decree
regarding, a violation of ethics codes, professional misconduct, unprofessional
conduct, incompetence or negligence in any state or country by any licensing
board or professional ethics body; and
m. Whether the reference will:
1. Make no recommendation of
licensure;
2. Recommend licensure
"without reservation", or
3.
Recommend licensure "with reservation", setting forth in writing the reasons
behind that conclusion.
(f) Each applicant for licensure shall submit the following documents in support of their application for licensure:
(1) The results of all criminal background
check(s) conducted in each state where the applicant has been a resident since
reaching the age of majority;
(2)
An original certified transcript, signed, and sealed by the school, of both the
undergraduate and graduate courses taken by the applicant, showing dates of
attendance, courses taken, grades and class hours earned, programs completed,
and degrees awarded by the colleges and universities attended;
(3) The EPPP exam score directly from the
association of state and provincial psychology boards (ASPPB);
(4) If the applicant answered yes to the
question described in Psyc 303.02(b)(20)a. on the application form, provide a
detailed explanation of each conviction and whether the applicant is in
compliance with any outstanding court orders for each conviction;
(5) If the applicant answered yes to the
questions described in Psyc 303.02(b)(20)e. on the application form, provide a
detailed explanation for each yes answer; and
(6) If the applicant answered yes to the
question described in Psyc 303.02(b)(2)g. on the application form, provide a
copy of any settlement or judgment entered into in the suit(s).
(g) The "Universal Application for Initial Licensure" form and supporting documentation shall:
(1) Be typewritten or legibly
printed;
(2) Have all sections
complete or designated as not applicable to the applicant; and
(3) Be signed and dated by the applicant in
accordance with Plc 304.05.
(h) Any application shall be considered incomplete if:
(1) Any portion of the form is
illegible;
(2) Any section of the
form is incomplete; or
(3) The form
is not signed and dated where required by the applicant.
(i) An application shall be considered to be complete as of the date the following has been received:
(1) A fully completed application form;
and
(2) All required supporting
documentation specified in Psyc 303.02 (b), (c) and (d).
(j) Within 30 days of the date the application is received the OPLC shall request the applicant to provide any additional information, documentation determined to be needed to clarify the application, or any materials related to the application not submitted.
(k) The OPLC shall approve or deny the application within 60 days of receipt of the completed application described in (i) above.
(l) If the application is denied, the applicant shall be provided an opportunity to request a hearing for reconsideration pursuant to Plc 304.10 on the deficiency issues identified by the OPLC.
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