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Forms and Applications

    Forms and Applications

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

    Application to become Licensed Assistant Behavior Analyst:

    Behavior Technician Registration 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)

    License Renewal Application:

    Changes to Licensee Information Form:

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

    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

     

    September 2023 Exam

    November 2023 Exam

    Application Deadline*

    September 1, 2023

    October 27, 2023

    Examination Date

    September 15, 2023

    November 10, 2023

    Results Released on or Before

    September 29, 2023

    November 24, 2023

     

     

    January 2024

    Exam

    March 2024

    Exam

    May 2024

    Exam

    July 2024

    Exam

    September 2024

    Exam

    November 2024

    Exam

    Application Deadline*

    January 5, 2024

    March 8, 2024

    May 3, 2024

    July 5, 2024

    September 6, 2024

    November 1, 2024

    Examination Date

    January 19, 2024

    March 22, 2024

    May 17, 2024

    July 19, 2024

    September 20, 2024

    November 15, 2024

    Results Released on or Before

    February 2, 2024

    April 5, 2024

    May 31, 2024

    August 2, 2024

    October 4, 2024

    November 27, 2024

     

    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: