21 NCAC 54 .2103 REINSTATEMENT

(a) The information required for each applicant requesting reinstatement of licensure after a license has been suspended due to non‑renewal shall consist of:

(1) completed reinstatement application form. The form shall include the following information:

(A) applicant's legal name;

(B) mailing address and telephone number;

(D) Social Security number;

(E) e-mail address;

(F) date and place of birth;

(G) licensure or applicant for licensure by another psychology board;

(H) if taken, the score on the Examination for Professional Practice in Psychology;

(I) whether applicant has previously applied for a license to practice psychology in North Carolina;

(J) whether the applicant was denied a professional license or permit, privilege of taking an examination, had a professional license or permit disciplined by any licensing authority in North Carolina or elsewhere, or charges are pending against a professional license or permit held by the applicant;

(K) whether the applicant has withdrawn an application for licensure or an application to take a professional licensing examination in North Carolina or elsewhere;

(L) whether the applicant has ever been convicted of, or entered a plea of guilty or nolo contendere to any felony or misdemeanor other than a minor traffic violation;

(M) other fields of work for which the applicant is licensed or certified; or has applied for licensure or certification;

(N) whether the applicant holds a diploma from the American Board of Professional Psychology;

(O) whether doctoral program was APA accredited at the time of graduation;

(P) names of graduate programs attended and dates degrees awarded;

(Q) names and mailing addresses of three professional references, other than supervisors;

(R) all work experience including, any graduate internship, practicum, or other supervised training experience that serves as the basis for current application for licensure;

(S) reason for reapplying for licensure in North Carolina;

(T) any disability that may require some special accommodation, as set forth in the ADA in taking licensing examinations;

(U) if applying for Health Services Provider Certification; and

(V) certify that the applicant has read and understands the public notice statement on employee misclassification maintained on the Board's website and whether the applicant has been investigated for employee misclassification within the past 12 months.

(2) documentation of having completed a minimum of 24 continuing education hours as specified in Rule .2104 of this Section during the two years preceding the date of application for reinstatement of licensure;

(3) completed supervision report form, if applicable; and

(4) payment of the renewal and reinstatement fees.

The information listed in this Paragraph shall be filed in the Board office within 30 days after a license has been suspended due to non-renewal.

(b) The information required for each applicant requesting reinstatement of licensure after a license has been suspended for more than 30 days due to non‑renewal or after a license has been voluntarily relinquished with the Board's , consent, pursuant to G.S. 90-270.148(h), shall consist of:

(1) typed or legibly printed, signed or digitally signed application form and supervision contract form;

(2) signed consent form, completed Fingerprint Record Card, and other such form(s) or information as required by the North Carolina Department of Justice to perform a criminal history record check;

(3) payment of fee required by the North Carolina Department of Justice to perform a criminal history record check;

(4) documentation of having completed a minimum of 24 continuing education hours as specified in Rule .2104 of this Section during the two years preceding the date of application for reinstatement of licensure;

(5) completed supervisory forms from present and past supervisors, if applicable, as set forth in G.S. 90-270.148(h);

(6) three completed reference forms from professionals who are familiar with the applicant's current work, one of which shall be from a doctoral level psychologist, as set forth in Rule .1701(a)(8) of this Chapter;

(7) written verification and report on the status of any occupational licensure, including dates of licensure and any disciplinary action which is pending or has been taken, sent directly to the Board from any other regulatory agency in North Carolina and any other jurisdiction in which the applicant has applied for a license, is currently licensed, or previously was licensed, if applicable;

(8) official graduate college transcripts sent directly to the Board by the training institution(s); and

(9) payment of the renewal and reinstatement fees within 30 days after receiving notification from the Board that reinstatement of licensure has been approved.

(c) An application shall contain all required materials as set forth in Paragraphs (a) and (b) of this Rule to be complete. An incomplete application shall be active for three months from the date of application. At the end of such time, if still incomplete, the application shall be void, and the applicant shall be deemed to have discontinued the application process. If the individual chooses to pursue licensure at a later date, the individual shall reapply.

(d) To be considered to have made application for reinstatement of licensure pursuant to Paragraph (b) of this Rule the information specified in Subparagraphs (b)(1) through (b)(4) of this Rule shall be filed in the Board office within 30 days of offering to practice or undertaking the practice of psychology in North Carolina.

(e) The Board shall require applicants for reinstatement to take the state examination.

History Note: Authority G.S. 90-270.143; 90-270.147(a)(2); 90-270.148.(f),(h); 90-270.155(a);

Eff. August 1, 1984;

Amended Eff. March 1, 2008; May 1, 1996; November 1, 1991; March 1, 1989;

Readopted Eff. April 1, 2020;

Amended Eff. August 1, 2021.