SPECIALTY SPECIFIC REQUIREMENTS FOR APPLICATION IN
REHABILITATION PSYCHOLOGY
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Name of Applicant: Email:
I wish to qualify for the “Senior” procedural option (15 years of practice following licensure)
PROFESSIONAL EXPERIENCE
Professional experience. Use format below (start with present position(s), list in reverse chronological order for entire career or 15 years, whichever is less
.
1. Organization: Inclusive Dates: From To Address Position or Title Supervisor (List person best able to evaluate your professional work in Rehabilitation Psychology)
Description of activities/responsibilities, emphasizing your work in Rehabilitation Psychology
Describe clinical training in pre-doctoral and post-doctoral internships and practica:
Describe other relevant experience(s) – for example, committees, consultation
2. Organization: Inclusive Dates: From To Address Position or Title Supervisor (List person best able to evaluate your professional work in Rehabilitation Psychology)
Description of activities/responsibilities, emphasizing your work in Rehabilitation Psychology
Describe clinical training in pre-doctoral and post-doctoral internships and practica:
Describe other relevant experience(s) – for example, committees, consultation
3. Organization: Inclusive Dates: From To Address Position or Title Supervisor (List person best able to evaluate your professional work in Rehabilitation Psychology)
Description of activities/responsibilities, emphasizing your work in Rehabilitation Psychology
Describe clinical training in pre-doctoral and post-doctoral internships and practica:
Describe other relevant experience(s) – for example, committees, consultation
Continue with same format if necessary:
List professional contributions such as major publications, special research projects, etc., and other professional qualifications not covered in this application form. Include offices and other major positions held in local, state, regional or national organizations.
List all current memberships in professional or learned, and related, organizations and level of membership (e.g., Fellow). For APA, include Division membership(s). Include consumer organizations such as Brain Injury Association, National Spinal Cord Injury Association, etc.
The applicant must send a current, updated copy of their CV with their application.
ENDORSEMENTS
It is the responsibility of the applicant to obtain a total of 4 individual endorsements by appropriately qualified professionals who are familiar with your competence in the specialty for which you are applying. The endorsers should be able to comment on your postdoctoral level practice in the specialty of rehabilitation psychology.
The required endorsements should be from two supervisors and two professional colleagues. Fellows of the APA or specialists certified by the ABPP are preferred, but not required.
The endorsements must be completed using the online Endorsement Form. The candidate should instruct the endorsee to go to the www.abrp.org website and click on the pdf form entitled Endorsement Form. The online Endorsement Form has fillable fields and the completed form should be submitted to ABPP.
REMINDERS:
Check list of required items:
Official Doctoral Transcripts sent directly from the Institution - Date sent (m/d/yyyy):
Four (4) Endorsement Forms:
http://www.abpp.org/files/page-specific/3361%20Rehab/14_ABRP_Endorsement_Form.docx
sent by four different people: (name) (name) (name) (name)
CV
Save this form to your computer, so that you will be able to upload when completing the application.
Complete the Online Application at: https://www.abpp.org/i4a/pages/index.cfm?pageid=3661
All application materials should be submitted to:
ABPP Central Office
600 Market Street, Ste. 201
Chapel Hill, NC 27516
Phone: 919-537-8031 Fax: 919-537-8034