Supervision Plan for Applicants and Provisional Members

Consent for Release of Information
This form may be used to obtain information from current or past employers and other regulators, or release information to current employers or other regulatory bodies concerning your eligibility for licensure and/or competency to practice psychology.
Name*

First NameLast Name
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I hereby give consent to my present or past employer(s) and other regulators to release information to the Saskatchewan College of Psychologists, and for the Saskatchewan College of Psychologists to release information to present employers or other regulatory bodies concerning my eligibility for licensure and/or competency to practice psychology.
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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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Consent for Release of Information