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Indiana Professional Licensing Agency

PLA > Professions > Indiana State Psychology Board > Limited Scope Temporary Psychology Permit Limited Scope Temporary Psychology Permit

LIMITED SCOPE TEMPORARY PSYCHOLOGY PERMIT

 

A person not currently licensed to practice psychology in Indiana; licensed to practice psychology without supervision by any 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.

 APPLICATION

APPLICATION INFORMATION

 

  • A person seeking a limited scope temporary psychology permit under this section shall complete an application form supplied by the board specifying the following:
  • The reasons for seeking a limited scope temporary psychology permit.
  • The type, extent, and specialization of psychological services that the applicant intends to, or may, provide.
  • The applicant's residence and office addresses and telephone numbers; e-mail address; United States Social Security number.
  • Statements regarding the psychologist's disciplinary history and fitness to practice.
  • Submit, with the application for a limited scope temporary psychology permit, the following:

                        (1)        One (1) recent passport-type photograph of the applicant, taken within eight (8) weeks prior to filing the application.

                        (2)        Proof of holding a current and valid unrestricted license to practice psychology without supervision in another state or jurisdiction.

                        (3)        The $50.00 fee.                                     

 OTHER PERTINENT INFORMATION

 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:

(1) review the material; and

(2) if appropriate, issue a limited scope temporary psychology permit.

Holders of 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.

 APPLICATION