Setting 1

Please select this link for the form  if your post-doctoral setting meets the requirements below:

Pursuant to Section 20-188-3(d)(A) of the Regulations of Connecticut State Agencies:  (i)  the setting shall employ on a full-time basis no fewer than two (2) individuals with acceptable evidence of professional identification as psychologists who are engaged in work in an area for which the applicant is qualified by his doctoral education in accordance with subsection (c) of this section; and (ii)  the setting shall provide the applicant an opportunity for regularly occurring professional interaction and collaboration with other disciplines, an opportunity to utilize a variety of techniques and interventions, and an opportunity to work with a broad range of populations and conditions; and (iii)  a licensed doctoral-level psychologist shall have direct and continuing administrative control of, as well as full professional responsibility and accountability for, the activities performed and services provided by the applicant; and (iv)  one or more licensed doctoral-level psychologists employed in the setting or under contract to the setting shall provide or participate on an active, ongoing basis in providing direct, face-to-face supervision or consultation to the applicant.

Setting 2

Please select this form if your post-doctoral setting meets the requirements below:

Pursuant to Section  20-188-3(d)B) (i)  of the Regulations of Connecticut State Agencies, the setting shall be either an institution licensed pursuant to subsection (a) of section 19a-491 of the general statutes or a facility operated by a state agency, municipality or private nonprofit corporation, including facilities for the care and treatment of mentally ill persons or persons with mental retardation or substance abuse problems; and (ii)  the setting shall be engaged in the delivery of mental health services; and (iii)  the setting shall provide the applicant an opportunity for continuous professional interaction and collaboration with other disciplines, an opportunity to utilize a variety of techniques and interventions, and an opportunity to work with a broad range of populations and conditions; and (iv)  the setting shall employ on a full-time basis a licensed, doctoral-level psychologist who is engaged in work in an area for which the applicant is qualified by his or her doctoral education in accordance with subsection (c) of this section and who shall participate on an active, ongoing basis in providing direct, face-to-face supervision or consultation to the applicant; and (v)  such licensed doctoral-level psychologist shall have direct and continuing administrative control of, as well as full professional responsibility and accountability for, the activities performed and services provided by the applicant; and (vi)  the setting shall contract or otherwise provide for the services of a licensed, doctoral-level psychologist, in addition to the psychologist  referenced  above, who shall participate on an active, ongoing basis in providing direct, face-to-face supervision or consultation to the applicant; and (vii)  both psychologists shall certify to the applicant's satisfactory completion of the post-doctoral work experience in accordance with subsection (e) of this section.