This is the Montana Board of Psychologists TEMP FORM, a three-page packet that documents supervision for a temporary permit: the Agreement of Supervision and the Report of Initiation of Temporary Permit Supervision. It is used by an applicant who only lacks the examination for licensure and will work under the direct supervision of a Montana-licensed psychologist. It is one of the temporary permit documents the Board publishes. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the Board publishes the original at boards.bsd.dli.mt.gov.
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What is TEMP FORM?
The Temporary Permit (for applicants who only lack the examination for licensure while under supervision) is the Montana Board of Psychologists TEMP FORM packet in which a supervisee and a Montana-licensed psychologist agree to supervision and report that supervision is starting.
The packet has three pages in two parts:
- Agreement of Supervision - Temp Permit (page 1). It records the supervisee, the institution or other setting, and the supervisor, who must be licensed as a Psychologist in the State of Montana. The supervisor assumes professional responsibility for the supervisee's psychological activities and services as required by ARM 24.189.633. Both the supervisor and the supervisee state that they have read that rule and agree to abide by it, and both sign and date.
- Report of Initiation of Temporary Permit Supervision (pages 2 and 3). It collects contact details for both people, the supervisee's birth date, doctoral degree and institution, relevant previous experience, the nature of the psychological activities to be supervised, the supervisor's areas of experience and competence, the supervision arrangements and the beginning date of supervision.
The form is issued by the Board of Psychologists of the State of Montana, and its forms are published through the Montana Department of Labor and Industry's Business Standards Division. The form states that a fee must be included with it; the amount is printed on the form and the Board can confirm it.
Who needs to file TEMP FORM?
The form is for an applicant who only lacks the examination for licensure and will practice psychology under supervision, together with the supervisor who takes responsibility for that work.
- The supervisee is named on page 1 and completes the supervisee section of page 2. The form asks for the date the doctoral degree was awarded and the institution that awarded it. The supervisee signs the Agreement of Supervision.
- The supervisor must be licensed as a Psychologist in the State of Montana, and the form asks for the supervisor's Montana license number. The supervisor assumes professional responsibility for the supervisee's psychological activities and services as required by ARM 24.189.633, signs the Agreement of Supervision and signs the end of the report.
The form asks whether the supervisor has been licensed for three years and for the supervisor's previous training and experience in supervision. It also asks the supervisor to confirm agreement to comply with the rules on supervision of non-licensed persons. The form names no other person who may sign for either party and prints no exclusions beyond these conditions.
When to file TEMP FORM
Complete the packet when a temporary permit supervision arrangement is being set up. The second part is a report of the initiation of supervision, and it asks for the beginning date of supervision. The form prints no separate deadline and no processing time. The form says a fee must be included, so have the payment ready when you submit. Contact the Board at (406) 444-5773 or [email protected] with timing questions.
How to fill out TEMP FORM
Name the supervisee and supervisor
On page 1, enter the supervisee's name, the institution or other setting where psychology is practiced, and the supervisor's name. The supervisor must be licensed as a Psychologist in Montana.
Sign the Agreement of Supervision
Read ARM 24.189.633, then have the supervisor and the supervisee each sign and enter the date at the bottom of page 1.
Enter supervisee and supervisor contacts
On page 2, give the supervisee's name, Social Security No., address, email and day phone. Then give the supervisor's name, Montana License No., address, email and day phone.
Describe the supervisee's background
Enter the birth date, the date the doctoral degree was awarded, the institution that awarded it, relevant previous experience and the nature of the psychological activities to be supervised.
Check the supervisor's areas of competence
Check each area a through l in which the supervisor has experience and competence sufficient to supervise, including the Adult, Children or Family options under a and b. Use line m to list other areas.
Answer the supervisor experience questions
On page 3, mark Yes or No for whether the supervisor has been licensed for three years, and list the supervisor's previous training and experience in supervision.
Enter the supervision arrangements
Enter the hours per week the supervisee will spend in psychological activities, the place or places of supervision, the expected number of supervisor visits and hours in direct contact, and the beginning date of supervision.
Confirm compliance and sign
Mark Yes or No to agreeing to comply with the rules on supervision of non-licensed persons, then have the supervisor sign under SUPERVISOR'S SIGNATURE.
Review and download the completed PDF
Check that names, license number, dates and Yes/No answers are complete and that every required signature is in place. Download or print the completed PDF from FillingPDF and assemble the packet with the fee as described under How to submit.
How to submit TEMP FORM
The form prints the Board of Psychologists' address for mail and for delivery, plus a phone number, an email address and a website. It names no online filing portal.
- By mail: State of Montana, Board of Psychologists, PO Box 200513, Helena, Montana 59620-0513.
- By delivery: 301 S Park, 4th Floor, Helena, Montana 59620-0513.
- Questions: (406) 444-5773, [email protected], www.psy.mt.gov.
Page 2 is marked "MUST INCLUDE" a fee, so send the payment with the form. The amount is printed on the form; confirm it and the accepted payment methods with the Board. Both people must sign the Agreement of Supervision, and the supervisor must sign the end of the report. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Leaving out the fee: page 2 is marked "MUST INCLUDE" a fee, so the packet should travel with payment.
- Submitting the Agreement of Supervision with only one signature; both the supervisor and the supervisee sign and date it.
- Signing the agreement without having read ARM 24.189.633, which both parties state they have read and agree to abide by.
- Naming a supervisor who is not licensed as a Psychologist in the State of Montana, or omitting the supervisor's Montana License No.
- Skipping the supervisor's signature at the end of page 3, which follows the Yes/No agreement to comply with the rules on supervision of non-licensed persons.
- Leaving the Yes/No boxes unmarked, including "Supervisor has been licensed for three years?".
- Omitting the beginning date of supervision, the weekly hours, the place or places of supervision or the expected supervisor visits and hours.
- Sending delivery-service packages to the PO Box, or mail to the 301 S Park street address, instead of the matching address printed on the form.
Frequently asked questions
What is the Montana temporary permit supervision form?
It is the Montana Board of Psychologists TEMP FORM, a three-page packet with an Agreement of Supervision and a Report of Initiation of Temporary Permit Supervision. It is for applicants who only lack the examination for licensure and will work under a Montana-licensed psychologist.
Who has to sign the temporary permit agreement of supervision?
Both the supervisor and the supervisee sign and date the Agreement of Supervision on page 1. The supervisor also signs at the end of the Report of Initiation of Temporary Permit Supervision on page 3. The form does not name anyone else who may sign for them.
Does the temporary permit form require a fee?
Yes. Page 2 is marked "MUST INCLUDE" a fee. The amount is printed on the form, and the Board of Psychologists can confirm it and the accepted payment methods at (406) 444-5773 or [email protected].
Where do I send the Montana temporary permit form?
Mail it to the Board of Psychologists, PO Box 200513, Helena, Montana 59620-0513. For delivery, the form prints 301 S Park, 4th Floor, Helena, Montana 59620-0513. The form names no online filing portal.
What is ARM 24.189.633 on the agreement of supervision?
It is the Administrative Rules of Montana provision cited on page 1. Under it the supervisor assumes professional responsibility for the supervisee's psychological activities and services, and both signers state they have read it and agree to abide by it.
Does the supervisor have to be licensed in Montana?
Yes. Page 1 states that the supervisor is licensed as a Psychologist in the State of Montana, and page 2 asks for the supervisor's Montana License No. Page 3 also asks whether the supervisor has been licensed for three years.
Can I fill out the temporary permit form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not the Board, and does not submit the form. You send the signed packet and fee to the Board through its mail or delivery address.
What information does the supervisor have to provide?
The supervisor gives a name, Montana license number and contact details. The supervisor also checks areas of experience and competence (a through l, plus other areas on m), lists supervision training and experience, and states the expected visits and hours of direct contact.
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