Limited Scope Temporary Psychology Permit
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Go to MyLicense.IN.gov and you will either need to create or login to your Access Indiana, single sign-on account. You will complete the online application and submit payment with a credit or debit card. Please allow 48 business hours for your application to be received and reviewed. You will be contacted by a customer service representative with details of what additional documentation is required to complete your application.
Basis for Limited Scope Temporary Permit: A person not currently licensed to practice psychology in Indiana licensed to practice psychology without supervision by an board or licensing agency of any other state or jurisdiction and would be eligible for licensure under IC 25-33-1-9, may apply to the board for a limited scope temporary psychology permit that, if issued under this section, shall remain valid for a nonrenewable period not to exceed a total of thirty (30) days in any two (2) year period.
Psychology Limited Scope Temporary Permit Application Instructions
- Completed Application: Applications may be submitted online at MyLicense.IN.gov or completed by paper and mailed to our office.
- Application fee of $50.00: Pay by credit or debit card for applications submitted online at MyLicense.IN.gov. If applying by paper/mail make checks or money orders payable to Indiana Professional Licensing Agency. All application fees are nonrefundable.
- Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree.
- Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
- Verification of Licensure: Verification of current and valid unrestricted license to practice psychology without supervision in another state or jurisdiction. Verifications must be submitted directly from the state of issuance. You may find the verification form here.
- Criminal Background Check Required: An individual applying for a license shall submit to a national criminal history background check at the cost of the individual. Please see the step-by-step directions on how to complete the fingerprinting process for your criminal background check by visiting www.in.gov/pla/3241.htm.
- Criminal background checks must be obtained after you apply for your license with the Board and prior to the issuance of a license.
The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.
Mandatory Disclosure of U.S. Social Security Number: Your social security number is being requested by this state agency in accordance with Ind. Code 4-1-8-1 and 25-1-5- 11(a). Disclosure is mandatory, and this record cannot be processed without it.
Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.
Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.
All information on the application shall be submitted under oath or affirmation, subject to penalties for perjury.
It is the responsibility of the applicant to ensure that all the materials are forwarded to the board at least ten
(10) business days prior to the date on which the applicant intends to provide psychological services in the state. Once the application is completed, the board, or a designee of the board, shall:
- Review the material; and
- If appropriate, issue a limited scope of temporary psychology permit.
Holders of a limited scope temporary psychology permits issued under this section shall comply with all statutes and rules of the board regarding scope of practice, conduct, and competency in psychology.
Within ten (10) business days of the end of the two (2) year period or the completion of thirty (30) days of service, whichever is earlier, the psychologist holding the limited scope temporary psychology permit under this section shall report to the board the locations of service and dates spent in the state of Indiana providing psychological services.
Failure to comply with these rules may result in the denial of future applications for a limited scope temporary psychology permit.
A psychologist who holds a limited scope temporary psychology permit under this section may be disciplined by the board under IC 25-1-9.