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Get APPLICATION FOR LICENSURE TO PRACTICE PSYCHOLOGY IN INDIANA - In

LICENSURE TO PRACTICE PSYCHOLOGY IN INDIANA State Form 27522 (R10 / 10-07) Approved by State Board of Accounts, 2007 * Your Social Security number is requested by this agency in accordance with IC 4-1-8-1, and it is mandatory that it be given. FOR AGENCY USE ONLY Date received (month, day, year) PSYCHOLOGY LICENSE Decision Initials Application fee TEMPORARY PERMIT Application fee Date fee paid (month, day, year) Date fee paid (month, day, year) Receipt number Receipt number quality p.

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