S.D. Admin. R. 20:60:05:05

Current through Register Vol. 50, page 162, June 24, 2024

Section 20:60:05:05 - Application forms

To qualify for licensure under SDCL chapter 36-27 A, 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.

S.D. Admin. R. 20:60:05:05

8 SDR 92, effective 2/3/1982; 12 SDR 151, 12 SDR 155, effective 7/1/1986; 18 SDR 74, effective 10/30/1991; 20 SDR 14, effective 8/11/1993.

General Authority: SDCL 36-27A-21.

Law Implemented: SDCL 36-27A-21.