Management Branch Office of Licensing

Psychologist Candidate (PSYC) Temporary Permit Application Checklist Information about the application process and how you will be contacted An Application Specialist will review your application based on the information you supply. If your application is incomplete, you will be contacted via the email address you provided. To monitor the status of your application, visit Online Services: apps.colorado.gov/dora/licensing/Default. Disclosure of Addresses: Consistent with Colorado law, all addresses and phone numbers on record with the Division of Professions and Occupations (DPO) are public record and must be provided to the public when requested. It is your responsibility to keep your address and contact information current in our system. Your email address is not open to public record, but must be provided at the time you register an account. If your email address is not current, it is possible you will not receive important information from DPO. You can change your address, email address and other information online by using Online Services: apps.colorado.gov/dora/licensing/Default. Application Expiration: Your application will be kept on file for one year from date of receipt in the Division of Professions and Occupations. Your file and all supporting documentation will be purged if you do not submit required documents and complete your application process in one year. You will need to resubmit a new application packet and fee after that time. If you submitted an application within the last year and were notified that you did not meet the requirements and you are submitting an update, you do not need to complete a new application or submit additional fees. Registered Psychotherapists: (previously known as “Unlicensed Psychotherapists”). Individuals who currently provide psychotherapy services, and/or are completing their experience and supervision for certification or licensure, are required to be registered in the Registered Psychotherapist Board Database pursuant to section 12-43-702.5, C.R.S., unless they are registered as a Psychologist Candidate. It is the applicant’s responsibility to comply with one of these requirements. Submission of this application does not guarantee receipt of a temporary permit nor authorize the applicant to begin accruing hours or practice psychotherapy. Mandatory Disclosure Statement: Section 12-43-214 of the Colorado Revised Statutes (C.R.S.) requires the mandatory disclosure of information to clients. This disclosure of information is viewed as significantly important in protecting the public from the unauthorized, unqualified, and improper application of psychotherapy. It is one of the few prohibited activities, which is also an unlawful act (a class 3 misdemeanor offense). You must provide mandatory disclosure to each client upon your first meeting. You may access the Model Mandatory Disclosure Statement on the Applications and Forms webpage: www.colorado.gov/dora/Psychologist_Applications_Docs. Permit Expiration: PLEASE BE ADVISED that candidate permits are a one-time permit that will expire four years from the date of issuance. To obtain a candidate permit, you must: Pay the Required Fee: You must pay the $40 application processing fee with a credit card or electronic check to complete the application process. All fees are non-refundable and are subject to change. Complete the Affidavit of Eligibility: You will be asked during the online application to attest to and provide information that you are lawfully present in the United States or otherwise eligible to work here. You may be required to upload documentation of your lawful presence.

1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800

F 303.894.7693 www.dora.colorado.gov/professions

Provide your Social Security Number or an Affidavit: As of January 1, 2009, a Social Security Number is required for all licensees. Exceptions are made for foreign nationals not physically present in the United States and for nonimmigrants in the United States on student visas who do not have a Social Security Number. These applicants must submit a signed Social Security Number Affidavit in lieu of a Social Security Number. The Social Security Number Affidavit is available on the Division of Professions and Occupations (DPO) website: www.colorado.gov/dora/DPO_Update_Contact. Provide Name Change Documentation (if applicable): If you already have another type of license in Colorado and your name has since changed, you are presenting documentation for licensure with a previous name, or if any required documentation has a different name on it, you will be required to upload proof of your name change. List and verify other Permits/Licenses: You will be asked to list ALL permits/licenses you hold or have held to practice psychology or a related profession. It is preferred that you provide scanned copy verification from the other state or jurisdiction website at the time of application. Otherwise, arrange for verification to be sent to the Office of Licensing – PSY Licensure (1560 Broadway, Suite 1350, Denver, CO 80202). The verification must indicate whether or not you have ever had disciplinary action taken against that permit/license. Answer the Screening Questions: You will be asked a series of screening questions related to your criminal history or complaints filed against you in other jurisdictions (if applicable). This may require you to upload court documents or other material. Please review DPO’s information regarding the disclosure of criminal history contained within these instructions. If you were educated outside the United States, you must obtain an education review from ONE of the below entities before applying: 

Educational Credential Evaluators (ECE): www.ece.org/; OR



World Education Services (WES): www.wes.org/; OR



American Association of Collegiate Registrars and Admissions Officers (AACRAO): www.aacrao.org/.

If you hold a doctorate degree from an APA-approved program, you must: Provide your official transcript(s): You must provide an official transcript(s) demonstrating your doctorate degree from a program approved by the American Psychological Association (APA) to the Office of Licensing – PSY Licensure ([email protected] OR 1560 Broadway, Suite 1350, Denver, CO 80202). For further information on APA or to see if your program is APA-approved, visit: www.apa.org/; If your degree was not APA-approved at the time of graduation, you must obtain an education review from the Center for Credentialing and Education (CCE) to determine if your education is equivalent to an APA-approved program before applying:

-OR-

Provide your CCE education review: If your education is found to be equivalent to an APA-approved program, you must arrange for CCE to submit your Education Approval Letter. If your education is not found to be equivalent to an APA-approved program, then you do not qualify for licensure. For further information or to request an education review, visit www.cce-global.org/.

If you have not yet graduated from an APA-approved doctorate program, you must: Provide your Certification of Doctorate Education Form: You must provide, at the time of application, your Certification of Doctorate Education Form completed by an appropriate school official verifying a doctorate program approved by the American Psychological Association (APA). You cannot complete and submit your application for a temporary permit until you upload your completed form. You may download the Certification of Doctorate Education Form on the Applications and Forms webpage: www.colorado.gov/dora/Psychologist_Applications_Docs.

1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800

F 303.894.7693 www.dora.colorado.gov/professions

IMPORTANT NOTICE TO:

All Applicants

FROM:

Director of the Division of Professions and Occupations

SUBJECT:

Licensure and Criminal History

Thank you for your interest in becoming a licensed* professional within the Division of Professions and Occupations. Before you submit your application, please be aware of a few facts regarding criminal conduct, convictions, and disciplinary actions in other states. The mission of the Division of Professions and Occupations is “public protection through effective licensure and enforcement.” One way the Division safeguards consumers is by issuing licenses to fully qualified, competent, and ethical applicants. During the licensing process – and depending on the specific application – the Division may ask whether you have ever been disciplined in any state, arrested, charged, convicted, or pled guilty to a crime. An arrest, subsequent criminal conviction, or disciplinary action is not an automatic disqualification from licensure. Rather, the appropriate board or program will look at the facts surrounding the criminal conduct and disciplinary action in addressing your license application. You should know that licensure is a privilege, not a right. One thing you must do to obtain the privilege is to be complete and accurate in disclosing information on your application. Be sure to list all relevant complaints, disciplinary actions, arrests, charges, or convictions in response to the appropriate licensure questions. Failure to fully and accurately disclose requested criminal history information, alone, could constitute grounds for denial of your application or revocation of your license. When requested, you must include information regarding prior conduct. This remains the case when the conduct is seemingly unrelated to the activities of a profession, and when the conduct involves deferred sentences or judgments. Remember, even following licensure, you are still required to notify your professional licensing board or program about subsequent convictions and disciplinary actions in other states. Please be aware that the Division conducts audits of its licensing database against several criminal and national disciplinary databases. This allows the Division to verify the truthfulness of your application and track subsequent criminal and disciplinary conduct after initial licensure. Keep in mind, your license will not necessarily be revoked, or your application denied, if you have been disciplined, arrested, charged or convicted. But, you will most likely be denied or revoked if you fail to disclose requested information. *The word "license" is used as a general term. While most of the professions and occupations are licensed, others may be registered, certified, or listed. For precise terminology and requirements related to a profession or occupation, please consult the website of the appropriate board or program.

1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800

F 303.894.7693 www.dora.colorado.gov/professions

Psychologist Candidate - Application Checklist.pdf

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