64B19-11.012 : Application Forms - Florida Administrative Rules, Law, Code, Register

Florida Department of State and Division of Library and Information Services

Rule: 64B19-11.012 Prev Up Next

Rule Title: Application Forms
Department:	DEPARTMENT OF HEALTH	Add to MyFLRules Favorites
Division:	Board of Psychology
Chapter:	APPLICATIONS, EXAMINATIONS, CRITERIA FOR LICENSURE

Latest version of the final adopted rule presented in Florida Administrative Code (FAC):

	Effective Date:	8/22/2022
	History Notes:	Rulemaking Authority 456.013, 456.025, 490.004(4), 490.005 FS. Law Implemented 456.013, 456.025, 456.0635, 490.005, 490.006 FS. History–New 6-25-02, Amended 5-24-09, 3-1-10, 5-23-10, 11-10-11, 6-18-12, 12-25-12, 10-28-13, 5-1-14, 11-2-14, 4-6-15, 12-3-15, 4-21-16, 9-27-16, 11-23-17, 2-18-19, 3-28-21, 6-21-21, 10-19-21, 8-22-22.
	References in this version:	Ref-13615 Form 4.ABPP Diplomate Verification Ref-14597 DH-MQA 1187 Application for Licensure as a Psychologist

History of this Rule since Jan. 6, 2006

Section	Description	ID	Publish Date

Final 64B19-11.012	Application Forms	26157910	Effective: 08/22/2022
Proposed 64B19-11.012	The Board proposes a rule amendment to update and incorporate application form DH-MQA 1187.	26016387	6/29/2022 Vol. 48/126
Development 64B19-11.012	The Board proposes a rule amendment to update and incorporate application form DH-MQA 1187.	25957896	6/10/2022 Vol. 48/113
Final 64B19-11.012	Application Forms	25097506	Effective: 10/19/2021
Proposed 64B19-11.012	The Board proposes a rule amendment that substantially re-writes Form 4.ABPP by reformatting the form.	24947932	8/31/2021 Vol. 47/169
Development 64B19-11.012	The Board proposes a rule amendment that substantially re-writes Form 4.ABPP by reformatting the form.	24882651	8/16/2021 Vol. 47/158
Final 64B19-11.012	Application Forms	24662073	Effective: 06/21/2021
Proposed 64B19-11.012	The Board proposes the removal of a portion of the rule as the incorporated form was recently added to the application contained in subparagraph (1) of the rule.	24442368	4/22/2021 Vol. 47/78
Development 64B19-11.012	The Board proposes the removal of a portion of the rule as the incorporated form was recently added to the application contained in subparagraph (1) of the rule.	24396681	4/8/2021 Vol. 47/68
Final 64B19-11.012	Application Forms	24318111	Effective: 03/28/2021
Public Hearing 64B19-11.012	To discuss proposed amendments to Rule 64B19-11.012, F.A.C. and the incorporated form. The rule was noticed in Vol. 46, No. 200, of the October .... Friday, January 29, 2021, at 8:00 a.m. EST, or as soon thereafter .... Telephone Conference Call: Meet Me#: 1 (888) 585-9008, Participation ....	24078133	1/8/2021 Vol. 47/05
Proposed 64B19-11.012	The Board proposes a rule amendment to revise and incorporate the application form DH-MQA 1187 and to update a statutory reference.	23756287	10/13/2020 Vol. 46/200
Development 64B19-11.012	The Board proposes a rule amendment to revise and incorporate the application form DH-MQA 1187 and to update a statutory reference.	23698378	9/28/2020 Vol. 46/189
Final 64B19-11.012	Application Forms	21473974	Effective: 02/18/2019
Proposed 64B19-11.010 ......	The purpose of the rule amendment is to update the incorporated forms and to include two additional forms.	21222938	12/5/2018 Vol. 44/235
Development 64B19-11.010 ......	The Board proposes the development to consider changes to applications.	20336552	4/25/2018 Vol. 44/81
Final 64B19-11.012	Application Forms	19709835	Effective: 11/23/2017
Proposed 64B19-11.012	The purpose of the amendment is to clarity the application.	19379938	9/6/2017 Vol. 43/173
Development 64B19-11.012	The Board proposes the development of a rule amendment to clarify the application.	19310292	8/18/2017 Vol. 43/161
Final 64B19-11.012	Application Forms	17994681	Effective: 09/27/2016
Proposed 64B19-11.010 ......	To incorporate changes to application required by HB 941.	17631707	6/9/2016 Vol. 42/112
Development 64B19-11.010 ......	To incorporate changes to applications required by HB 941.	17560121	5/23/2016 Vol. 42/100
Final 64B19-11.012	Application Forms	17385715	Effective: 04/21/2016
Proposed 64B19-11.012	The proposed rule amendments are intended to incorporate the revised licensure application in the respective rule and to delete unnecessary language from the rule.	17214122	2/26/2016 Vol. 42/39
Development 64B19-11.012	The Board proposes the development of rule amendments to incorporate the revised licensure application in the respective rule and to delete unnecessary language from the rule.	17131672	2/10/2016 Vol. 42/27
Final 64B19-11.012	Application Forms	16790426	Effective: 12/03/2015
Proposed 64B19-11.001 ......	To update and revise Forms DH-MQA 1187 and DH-MQA 1221.	16607775	10/13/2015 Vol. 41/199
Development 64B19-11.001 ......	To update and revise Forms DH-MQA 1187 and DH-MQA 1221.	16301740	8/4/2015 Vol. 41/150
Final 64B19-11.012	Application Forms	15821299	Effective: 04/06/2015
Proposed 64B19-11.012	To revise the application processing and licensure fees on form DH-MQA 1187, Psychologist Licensure Application.	15663965	2/13/2015 Vol. 41/30
Development 64B19-11.012	To revise the application processing and licensure fees on form DH-MQA 1187, Psychologist Licensure Application.	15593349	1/28/2015 Vol. 41/18
Final 64B19-11.012	Application Forms	15193612	Effective: 11/02/2014
Proposed 64B19-11.012	To revise the “Special Testing Accommodations” section of form DH-MQA 1187, “Psychologist Licensure Application.”	15025705	9/5/2014 Vol. 40/173
Development 64B19-11.012	To update licensure application.	14970415	8/22/2014 Vol. 40/164
Final 64B19-11.012	Application Forms	14455345	Effective: 05/01/2014
Change 64B19-11.012	Application Forms	14329342	3/17/2014 Vol. 40/52
Change 64B19-11.012	Application Forms	14213815	2/21/2014 Vol. 40/36
Proposed 64B19-11.012	Amendment to reflect $5.00 increase in Laws and Rules CBT Exam.	13909138	12/9/2013 Vol. 39/237
Development 64B19-11.012	The rule amendment is to reflect an increase of $5.00 in the Laws and Rules CBT Exam Fee	13858310	11/22/2013 Vol. 39/228
Final 64B19-11.012	Application Forms	13680315	Effective: 10/28/2013
Change 64B19-11.012	Application Forms	13487285	9/9/2013 Vol. 39/175
Change 64B19-11.012	Application Forms	13320639	8/1/2013 Vol. 39/149
Change 64B19-11.012	Application Forms	13279414	7/24/2013 Vol. 39/143
Proposed 64B19-11.012	The Board proposes the rule amendment in order to incorporate the revised “Application for Psychologist Licensure,” form DH-MQA 1187, into the current rule.	12900241	4/19/2013 Vol. 39/77
Development 64B19-11.012	The Board proposes the rule amendment in order to incorporate the revised “Application for Psychologist Licensure,” form DH-MQA 1187, into the current rule.	12842138	4/5/2013 Vol. 39/67
Final 64B19-11.012	Application Forms	12366450	Effective: 12/25/2012
Proposed 64B19-11.012	The Board proposes the rule amendment in order to incorporate the revised psychologist licensure application into the current rule.	12197670	10/25/2012 Vol. 38/58
Development 64B19-11.012	The Board proposes the rule amendment in order to incorporate the revised psychologist licensure application into the current rule.	12130740	10/9/2012 Vol. 38/46
Final 64B19-11.012	Application Forms	11599762	Effective: 06/18/2012
Proposed 64B19-11.010 ......	The proposed rule amendments are intended to incorporate the revised application form, limited licensure application form and the revised provisional licensure application form into the Board’s respective rules.	11223499	3/16/2012 Vol. 38/11
Development 64B19-11.010 ......	The Board proposes the development of rule amendments to incorporate the revised licensure application, limited licensure application, and provisional licensure application in the respective rules.	11075089	2/17/2012 Vol. 38/07
Development 64B19-11.001 ......	The Board proposes the development of rule amendments to incorporate the revised re-examination form and the revised licensure application into the respective rules.	10943169	1/27/2012 Vol. 38/04
Final 64B19-11.012	Application Forms	10587858	Effective: 11/10/2011
Proposed 64B19-11.012	The proposed rule amendments are intended to incorporate the revised licensure application and supervising verification form into the rule.	10384449	9/9/2011 Vol. 37/36
Development 64B19-11.005 ......	The Board proposes the development of rule amendments to address the requirements for supervised experience and to address various forms for licensure.	9509121	12/23/2010 Vol. 36/51
Final 64B19-11.012	Application Forms	8669489	Effective: 05/23/2010
Correction 64B19-11.012	Application Forms	8609252	5/7/2010 Vol. 36/18
Proposed 64B19-11.012	The Board proposes the rule amendment to modify the application forms.	8467244	4/2/2010 Vol. 36/13
Development 64B19-11.012	The Board proposes the rule review to delete unnecessary language and to add new language to clarify the application forms.	8410402	3/19/2010 Vol. 36/11
Withdrawal 64B19-11.012	Application Forms	8410305	3/19/2010 Vol. 36/11
Proposed 64B19-11.012	The Board proposes the rule amendment to modify the application forms.	8351135	3/5/2010 Vol. 36/09
Final 64B19-11.012	Application Forms	8309231	Effective: 03/01/2010
Proposed 64B19-11.012	The Board proposes the rule amendment to modify the Application form.	8042190	12/18/2009 Vol. 35/50
Development 64B19-11.012	The Board proposes the rule amendment to modify the Application Form.	7405191	7/24/2009 Vol. 35/29
Final 64B19-11.012	Application Forms	7150954	Effective: 05/24/2009
Proposed 64B19-11.012	The Board proposes to incorporate an updated application form.	6767804	2/13/2009 Vol. 35/06
Development 64B19-11.012	The Board proposes to incorporate an updated application form.	6633556	1/16/2009 Vol. 35/02
Final 64B19-11.012	Application Forms	2485545	Effective: 06/25/2002

Under Florida law, E-mail addresses are public records. If you do not want your E-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.