Forms and Applications

Application to become Licensed Behavior Analyst (Reciprocity Information listed below): 

• Behavior Analyst Licensure Application
• Temporary Licensure Supervisory Agreement and Required Supervision Evaluation Form

Application to become Licensed Assistant Behavior Analyst:

• Assistant Behavior Analyst Licensure Application
• Licensed Assistant Behavior Analyst Supervision Documentation Form

Behavior Technician Registration Form:

• Behavior Technician Registration Form
• Behavior Technician Removal Form

Continuing Education Reporting Form:

(Due June 30 each year unless license issued within the 6 months prior, by mail, to MS Autism Board, PO Box 20, Jackson, MS  39205)

• Continuing Education Reporting Form
• Continuing Education Board Review Request Form - For greater than 50% online CE acceptance

License Renewal Application:

• Renewal Application

Changes to Licensee Information Form:

• Change of Contact Information Form
• Name Change Form

Request for Investigation of a Licensed Behavior Analyst or a Licensed Associate Behavior Analyst:

• Request for Investigation Form

Reciprocity Applications

Pursuant to the provisions of the Military Family Freedom Act, Mississippi shall recognize occupational licenses obtained from other states for military members and their families. The issuance of a license by reciprocity to a military-trained applicant or military family member shall be subject to the provisions of Miss. Code Ann. §73-50-1.  If you are a military-trained applicant, military spouse or military dependent, please notify our office at the time of the application.

Application for Licensing as a Behavior Analyst through MFFA

Pursuant to the provisions of the Universal Recognition of Occupational Licensure Act, Mississippi shall recognize occupational licenses obtained from other states by residents of Mississippi. The issuance of a license pursuant to the Universal Recognition of Occupational Licensure Act shall be subject to the provisions of Miss. Code Ann. §73-50-2. If you are seeking reciprocity through the provisions of the Universal Recognition of Occupational Licensure act, please notify our office at the time of the application. 

Application for Licensing as a Behavior Analyst through UROLA

Individuals seeking reciprocity through the Military Family Freedom Act or the Universal Recognition of Occupational Licensure Act are still required to submit an application for licensure, including the completion of a criminal background check and fingerprinting. 

Oral Examination and Meeting Date Schedule

Application Requirements and the Oral Examination (Jurisprudence Exam)

*All Documents must be received on or before the Application Deadline date in order to be considered on-time. It is noted that the current capacity of an oral examination day is approximately 10 candidates. Therefore, a completed application near the application deadline does not ensure that you will be accepted for the oral examination that cycle. It is best to get your application in as early as possible prior to the upcoming deadlines.  

Your standard application for licensure should be submitted at minimum two weeks prior to the application deadline. A complete application includes:

• Completed Application Form along with signed and notarized Affidavit and signed Criminal Background Request for Fingerprint Card.
• Application Fee ($250.00 for Behavior Analyst; $100.00 for Assistant Behavior Analyst; additional $75 for Temporary License).
• Criminal Background Check processing fee ($35.00; should accompany Application Form and can be included with Application Fee).
• Completed Fingerprint Card (upon receipt of initial application the Executive Director of the Board will send the required card to the applicant). It is noted that a standard FBI Fingerprint Card provided by local law enforcement can also be accepted.  
• All official undergraduate and graduate transcripts attended from all institutions via mail. Transcripts sent directly from the applicant and/or via email from the institution will not be accepted.
• Board receipt of passed MDPS background check based on submitted Fingerprint cards from applicant (applicant must submit directly to Board).

Oral examination study materials will be emailed to applicants scheduled for the examination. The materials are also available here:

• Jurisprudence Examination Study Materials