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General Inquiries
3605 Missouri Boulevard
P.O. Box 1335
Jefferson City, MO 65102-1335
573.751.0099 Telephone
573.526.0661 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
scop@pr.mo.gov
https://pr.mo.gov/psychologists.asp
Forms
PLEASE READ THE ENTIRE INSTRUCTION LETTER BELOW BEFORE BEGINNING TO COMPLETE ANY OF THE FORMS.
Application Instruction Letter
375-0332 (Application for Licensure/Temporary Licensure/Provisional Licensure)
375-1019 (Educational Data - Description of Course Work)
375-0334 (Verification of Post- Degree Supervised Professional Experience)
375-0333 (Post-Degree Supervised Professional Experience)
375-0335 (Verification of Licensure Form)
375-0336 (Social Security Number Disclosure Notice)
375-0313 (Application for Duplicate Wall Hanging License)
375-0550 (Reference of Applicant for Licensure as a Psychologist)
375-0590 (Supervision Agreement)
375-1076 (Supervised Pre-Doc Hours Summary Form)
375-0314 (Application for Health Service Provider (HSP) Certification)
375-0314 (Applicant Release)
375-1135 (Request for Extension of Provisional License)
375-1147 (Change in Supervisor or Setting of Supervised Licensee
375-1157 (Restoration of License)
375-1158 (Request for Testing Accommodations)