Application Form for Provisional Registration

Application Form for Provisional Registration
Section 1 - Personal Information
Applicant Name*

First NameMiddle NameLast Name
Gender*
Former Name (if applicable)

PrefixFirst NameLast Name
Date of Birth*

MonthDayYear
Current Mailing Address*

Street Address

Street Address Line 2

CityProvince/State

Postal/Zip Code
Contact #*
Secondary Contact #
Email*
Languages in which you are competent to provide psychology services:*

EnglishFrenchCantonesePunjabiMandarinSpanishAmerican Sign LanguageOther

Section 3 - Authorized Practice Endorsement (APE)

*See section 23 of The Psychologists Act, 1997. If you answer yes to the question below, please complete the Self-Report for APE Competence.
Will you be applying for the APE?*

YesNo
Section 4 - Graduate Education and Foundational Knowledge

Please have official transcripts from all post-secondary masters and doctoral education related to registration criteria sent directly from the issuing institution to the Saskatchewan College of Psychologists, 1026 Winnipeg Street, Regina, SK, S4R 8P8 or skcp@sasktel.net.

Education*

	Name of Institution/University and Location	Length of Program	Degree	Date Completed	Distance Education (Yes/No/Partial)
1
2
3
4
5

If applicable, the date you wrote the Examination for Professional Practice in Psychology (EPPP):

MonthDayYear
Please have marks forwarded directly to the College by the Association of State and Provincial Psychology Boards.

Foundational Knowledge in Psychology

One must meet the Foundational Knowledge (FK) requirements, as required per Saskatchewan legislation. There are four FKs, as defined below. To meet these foundational knowledge courses, one must provide evidence by way of the official graduate and/or undergraduate transcripts that they have either two senior-level (300 & 400) undergraduate psychology courses that are substantive in the FK area OR one graduate level psychology course that is substantive in the FK area. Psychology courses must be completed within the last 10 years.

This section does not apply to those who are applying with a CPA- or APA-accredited doctoral degree in psychology, as it is assumed that these applicants have met the FK requirements as part of their doctoral program.
I completed a CPA/APA-accredited doctoral degree and understand I am not required to fill out the following section of the Application Form for Provisional Registration.

Foundational Knowledge Course Documentation
(Reproduced with thanks to and permission from the College of Psychologists of British Columbia - Application for Registration)

FK Area 1. Knowledge in the Biological Bases of Behaviour

Examples of psychology courses include 1.1 Physiological Psychology; 1.2 Comparative Psychology; 1.3 Neuropsychology; 1.4 Sensation and Perception; 1.5 Psychopharmacology.

FK Area 2. Knowledge of the Cognitive-Affective Bases of Behaviour

Examples of psychology courses include 2.1 Learning; 2.2 Cognition; 2.3 Motivation; 2.4 Emotion.

FK Area 3. Knowledge of the Social Bases of Behaviour

Examples of psychology courses include 3.1 Social Psychology; 3.2 Group Processes; 3.3 Community Psychology; 3.4 Environmental Psychology; 3.5 Organizational and Systems Theory; 3.6 Cultural Issues.

FK Area 4. Knowledge of Psychology of the Individual

Examples of psychology courses include 4.1 Personality Theory; 4.2 Human Development; 4.3 Psychopathology; 4.4 Individual Differences.

Section 5 - Signatory Attestation

I attest that the information provided on this application form is true and correct. If approved as a provisional member, I hereby agree to adhere to the Saskatchewan legislation that governs the Saskatchewan College of Psychologists (College), as well as all College policies and Professional Practice Guidelines, CPA ethical standards, and relevant provincial and federal legislation.
Applicant Signature*

Clear
Date*

MonthDayYear
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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