Login
Psychology Credentialing Request
Volunteer Request

Psychology Credentialing Request

Credentialing is required for anyone who is at the masters or doctoral level in psychology. When requesting credentialing for a new candidate, the requestor/supervisor/PI should complete the form below, which will be forwarded to Clinical Psychology department. Once received, the required registration documents and credentialing information will be sent to your candidate for completion. If you are requesting credentialing for multiple candidates, please submit a form for each one.

UPDATE TO PREVIOUS REQUEST SUBMISSION?: Did any requirements change for your candidate after last credentialing request submission? If yes click here to notify credentialing team with the updates instead of submitting a new request.

All fields marked with asterisk (*) are required.
Requestor's Information
Requestor Name
Requestor Email
Candidate's Information
First Name
MiddleName
Last Name
Email
Additional Information
Entity:
Title
NYSPI Volunteer?
Please note that the Requirements for Psychology Credentialing must be completed within 2 weeks or before the candidate starts any clinical job duties.
Anticipated Start Date (for Clinical activities/Exempt)
PI/Faculty Supervisor
PI/Faculty Supervisor Email
Reason for Request
Is candidate postdoctoral fellow or limited permit practitioner?
Will Candidate use HRO to submit documents?
Additional Notes/Comment