Review Application

In This Section

Step 1: Demographic DataEdit

First Name *:

Middle Name:

Last Name *:

Other Name Listed on Documents:

Address 1 *:

Address 2:

City *:

State / Province:

Zip:

Work Phone *:

Home Phone *:

E-mail Address *:

Sex:

Ethnicity:

Step 2: Work ExperienceEdit

Primary Place of Employment*:

Job Title*:

Languages Other Than English You Speak Fluently:

Will you be awarded a stipend or salary increase for holding the NCSP Credential?

If yes, what is the amount or percentage of the stipend?

What is the name of the school district or employer providing that stipend increase?

Step 3: Education and TrainingEdit

1. Education and Graduate Preparation

2. Total Credit Hours

Total Credit Hours in School Psychology:
(Excluding Internship)

Total Internship Credit Hours:

Total Other Graduate Credit Hours:

Total:

Step 4: Certification and LicensureEdit

Step 5: Ethics ValidationEdit

Have you ever been found in violation of ethical principles by an ethics or professional practices board?
Have you ever voluntarily surrendered a professional credential in response to an ethics charge?
Have you ever received disciplinary action from an ethics or professional practices board?
Have you ever had a professional credential revoked, suspended, or limited by an ethics or professional practices board?
Have you ever been convicted of, or pleaded guilty or nolo contendere to a felony, misdemeanor, or other offense, other than a minor traffic offense, in a federal, state, or municipal court?
Have you ever received formal disciplinary action by an employer or supervisor based wholly or in part on ethical issues?

If the answer to any of the above questions is "yes," please provide a complete explanation below. The matter will be referred to NASP's Ethics and Professional Practices Committee prior to review of your materials.

I verify that the information herein is true and accurate. I further affirm that I will abide by NASP's Principles for Professional Ethics and agree to submit to NASP procedures for adjudication of alleged violations of same.

Step 6: Official DocumentsEdit

I have completed and uploaded the following documents:

All Official Transcripts

School Psychologist Praxis Examination Score Report

Verification of Completion of School Psychology Program Form

Practica Verification Form

Internship Verification Form

Step 7: Portfolio

Domain Response Form:

Problem-Solving Report: