• Provisional Applicant Reference Form

    Provisional Applicant Reference Form

    Practice of Psychology in the Core Competency Areas
  • Directions for PROVISIONAL APPLICANTS:

    • Complete Section 1 - Provisional Applicant Information and Section 2 - Referee Contact Information on the following pages. Do not fill in any information outside of those two sections.
    • Once sections 1 and 2 have been completed, proceed to the final page of the form and submit. Once submitted, an electronic copy of this form will be automatically forwarded to your referee so they may provide their reference.
    • Repeat this process for each of your three referees. 
    • NOTE: Two of the three required references must come from psychologists. One reference may be submitted by a professional who is a member of a health-related regulated profession, and who is registered with their regulator under a graduate degree (i.e. master's level RPN, registered MSW). If you have questions about acceptable referees, please contact the College office.

     

    Directions for REFEREES:

    • Proceed to Section 3 - Referee Registration Information and complete all relevant sections.
    • Once section 3 has been completed, fill out Section 4 - Professional Relationship with Provisional Applicant and Section 5 - Assessment of Provisional Applicant's Knowledge and Skills in the Five Core Competency Areas. Note that all referees must provide information regarding the provisional applicant's knowledge and skill in the practice of psychology within the core competency areas included on this form.
    • Please ensure that you can adequately speak to each of the psychological competencies. If you are unable to do so, your reference will likely not be accepted.
    • Once complete, please sign and submit the form. This completed form will be shared with the Saskatchewan College of Psychologists and added to the provisional applicants' file.
    • NOTE: If you are not a psychologist, you must possess a graduate degree in another health-regulated profession, and be a member of that health-regulatory body in order to provide a reference.
  • Section 1 - Provisional Applicant Information

    To be filled out by the provisional applicant. All marked fields are required.

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  • Please input your referee's contact information on the following page, then proceed to the end of the form and submit. A copy of the electronic form will be forwarded to your referee for completion. Separate forms must be completed for each of your three references.

    Thank you.

  • Section 2 - Referee Information

    To be filled out by the provisional applicant. All marked fields are required.

  • Section 3 - Referee Registration Information

    A or B to be filled out by the referee only.

  • A. If the reference is being provided by a psychologist:

    Registration/License/Certification #    in the province/state of   . Effective date   Pick a Date      

  • B. If the reference is being provided by a professional registered with another health-related regulatory body:

  • Registration/License/Certification #    in the province/state of   . Your highest held degree     .  Effective date   Pick a Date      

  • Section 4 - Professional Relationship with Provisional Applicant

    To be filled out by the referee only. All fields are required.

  • Applicant has been know to me for and/or    from   Pick a Date  to   Pick a Date .

  • Section 5 - Assessment of Provisional Applicant's Knowledge and Skills in the Five Core Competency Areas

    To be filled out by the referee only. All fields are required.

  • Please comment on the provisional applicants' knowledge and skill with respect to the following core psychological competencies.

  • 1. Interpersonal Relationships

  • Communicates effectively with:

  • Establishes and maintains rapport with:

  • 2. Assessment and Evaluation

  • Diagnositic classification (please comment only if you have an authorized endorsement to diagnose) or identification of strengths/competencies:

  • 3. Intervention and Consultation

  • 4. Research

  • 5. Ethics and Standards

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  • Saskatchewan College of Psychologists

    1026 Winnipeg Street, Regina, SK S4R 8P8
    Telephone: 306-352-1699/Fax: 306-352-1697
    Email: skcp@sasktel.net
    Website: www.skcp.ca

     

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