To qualify for licensure under SDCL chapter 36-27A, the applicant shall complete and submit to the board an application form supplied by the board. The form shall contain the following information:
- (1) Name, address, and telephone number;
- (2) Date and place of birth;
- (3) A description of licenses held in other states;
- (4) A request for endorsement, if applicable;
- (5) Date and circumstances of previous national standardized examination;
- (6) A statement of any psychology licensure denied;
- (7) A statement of any professional sanctions as a psychologist;
- (8) A statement of any criminal record;
- (9) A statement of education and training;
- (10) Official transcripts of education;
- (11) A description of internship;
- (12) A description of professional experience;
- (13) Compliance with SDCL 36-27A-12 unless exempted; and
- (14) Notarized signature of applicant.
Source: 8 SDR 92, effective February 3, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 18 SDR 74, effective October 30, 1991; 20 SDR 14, effective August 11, 1993.
General Authority: SDCL 36-27A-21.
Law Implemented: SDCL 36-27A-21.