D2P2 Forms

FORMS FOR REVISIONS/UPDATES/ADDITIONS
ASPPB/National Register Designation List

Please click on one of the forms below indicating if you are representing a university or a licensure board. Indicate the changes or additions in your online listing by completing the forms.

STEP 1

University/Institutions Form State/Provincial/Territorial Boards Form

STEP 2

University/Institution:

Address:

City:

State/Province/Territory:

Zip/Postal Code:

Country:

Telephone:

Fax:

Email:

Web Site:

STEP 3

Is the information above different from the current listing?
yes no

STEP 4

STEP 5 (a)

STEP 5 (b)

STEP 5 (c)

Current online program listing is correct. No changes needed.
Current online program listing is not correct. Please make the above changes.

The following program(s) should be deleted:

Title of Psychology Program(s) Degree(s) Offered (Ph.D., Psy.D., Ed.D.)

The following program(s) has been added:*

Title of Psychology Program(s) Degree(s) Offered

Program Director Date Program Was Initiated

* Please be certain to send current supporting documentation, e.g., catalogs, brocures, and/or program descriptions.
The following reorganization of program(s) or name change(s) has been made:

Title of Psychology Program(s) Degree(s) Offered

Program Director Date Program Was Initiated

STEP 6

Name of person completing form:

Title:

Telephone:

Email:

Date:

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STEP 1

State/Province/Territory

Address:

City:

State/Province/Territory:

Zip/Postal Code

Country:

Telephone:

Fax:

Email:

Web Site:

STEP 2(a)
The following program(s) is not currently listed, but should be considered for designation:

State/Province/Territory	University

Department	Program

STEP 2(b)
The following program(s) are currently listed, but the Board would like a re-examination by the ASPPB/National Register Designation Committee. (Please be certain to identify which of the guidelines do not appear to be met for any program(s):

State/Province/Territory	University




Title of Psychology Program(s)

Guidelines Not Met

Name of person completing form:
Title:
Telephone:
Email:
Date:

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Updated 2/24/2004

STEP 1
University/Institutions Form	State/Provincial/Territorial Boards Form