21 N.C. Admin. Code 54 .2101 - LICENSE RENEWAL FORM

(a) A licensee shall renew his or her license by October 1 of each even numbered year by submitted to the Board a completed renewal application form.

(b) The form shall include the following information:

(1) legal name;

(2) license number;

(3) current addresses and email address;

(4) telephone number;

(5) area of specialty;

(6) principal setting of practice;

(7) any malpractice actions;

(8) whether denied a professional license, had a professional license disciplined, or have pending charges against a professional license;

(9) whether convicted of, or entered a plea of guilty or nolo contendere to any felony or any misdemeanor involving moral turpitude, misrepresentation or fraud in dealing with the public, or conduct otherwise relevant to fitness to practice psychology, or a misdemeanor charge reflecting the inability to practice psychology with due regard to the health and safety of clients or patients;

(10) whether completed required continuing education during the preceding two years, as required by Rule .2104 of this Section; and

(11) a complete supervision report shall be submitted.

(c) Failure of a postal service or an internet provider to deliver the renewal application or failure of a licensee to submit all required information on the form by the deadline set forth in G.S. 90-270.14(a), shall not excuse the late fee or prevent license suspension.

Notes

21 N.C. Admin. Code 54 .2101

Authority G.S. 90-270.9; 90-270.14;
Eff. September 1, 1982;
Amended Eff. May 1, 1996; October 1, 1991; August 1, 1984. Readopted by North Carolina Register Volume 34, Issue 21, May 1, 2020 effective 4/1/2020.