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Psychology Board Form Change of Principal Supervisor 2020-2025

Chps 76 2020-2025 Form

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Understanding the CHPS 76 Form

The CHPS 76 form is utilized by the Psychology Board for the purpose of changing the principal supervisor for a psychology intern or resident. This form is essential for ensuring that the intern or resident is under proper supervision as they complete their training. The form requires detailed information about both the intern and the new supervisor, including their qualifications and the nature of the supervision arrangement.

Steps to Complete the CHPS 76 Form

Completing the CHPS 76 form involves several key steps:

  1. Gather necessary information about the intern, including their full name, license number, and current supervisor.
  2. Provide details about the new principal supervisor, including their qualifications and license information.
  3. Clearly outline the reasons for the change in supervision.
  4. Review the completed form for accuracy and completeness.
  5. Submit the form according to the specified submission methods.

Legal Use of the CHPS 76 Form

The CHPS 76 form serves a legal purpose in documenting the change of supervision for psychology interns. Proper use of this form is crucial for compliance with state regulations governing psychological practice. Failure to submit the form can result in legal complications for both the intern and the supervisor, potentially affecting the intern’s ability to complete their training and obtain licensure.

Obtaining the CHPS 76 Form

The CHPS 76 form can typically be obtained directly from the Psychology Board's official website or through their office. It is important to ensure that you are using the most current version of the form, as outdated forms may not be accepted. If you have difficulty accessing the form online, consider contacting the board for assistance.

Form Submission Methods

Submitting the CHPS 76 form can be done through various methods, depending on the guidelines set by the Psychology Board. Common submission methods include:

  • Online submission via the board's official portal.
  • Mailing a hard copy to the designated office address.
  • In-person submission at the board's office during business hours.

Key Elements of the CHPS 76 Form

The CHPS 76 form includes several key elements that must be filled out accurately. These elements typically include:

  • Intern's personal information, including name and contact details.
  • Current supervisor's details and their license information.
  • New supervisor's qualifications and license number.
  • Reason for the change in supervision.
  • Signatures from both the intern and the new supervisor to confirm the agreement.

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AU CHPS-76 2020
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AU CHPS-76 2017
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