BDD Psychologist Requirements Checklist.docx

BUREAU OF DISABILITY DETERMINATION REQUIREMENTS CHECKLIST-PSYCHOLOGIST

INVITATION FOR BID/IFB #

CASE REVIEW SERVICES

Note: Please check the appropriate box and submit a copy of the document on the line that states “submit copy.” Bidders with multiple employees or subcontractors must submit a copy of this completed form for each individual to include themselves if they are also performing case reviews.

PSYCHOLOGIST ONLY – COMPLETE AND RETURN WITH BID

INDIVIDUAL PERFORMING SERVICES: ___________________________________

BIDDER NAME: ______________________________________________________

BIDDER EMAIL ADDRESS: _____________________________________

BIDDER PHONE: _____________________________________

A) Listed in The National Register of Health Service Psychologists and possess two years of supervised clinical experience as a psychologist in health service, at least one year of which is post master’s degree; Or C) Possess a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the Council for Higher Education Accreditation, formerly the Council on Post-Secondary Accreditation and possess two years of supervised clinical experience as a psychologist in health service, at least one year of which is post master’s degree *Submit one copy of appropriate certification with your bid*

*Submit a criminal background check with your bid