TEMPORARY REGISTRATION - Louisiana State Board of Examiners - lsbep 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by attaching a current passport-sized photo on the first page as required. Ensure it is clear and recent.
3. Fill out Part I: General Information. Provide your full name, maiden/alias, social security number, date and place of birth, contact numbers, and addresses accurately.
4. In Part II: License History, indicate your state of residence and whether you are licensed for independent practice. Include your license number and original issue date if applicable.
5. Complete Part III: Dates and Location of Practice in Louisiana. Specify the temporary practice location, organization details if applicable, and describe your psychological duties.
6. In Part IV: Attestation, answer all questions truthfully regarding any disciplinary actions or legal issues. Attach explanations if necessary.
7. Finally, review all sections for accuracy before signing the notarized affidavit in Part V. Ensure all required documents are included before submission.

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