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Please Read Carefully: This application is for graduate students who completed a Bachelor of Social Work (BSW), Master of Arts (MA) Master of Science (MS), Master of Social Work (MSW) or Education Specialist (Ed.S) in School Psychology through the University of Memphis seeking a School Service License.

License applications will be processed and submitted to the Tennessee Department of Education in 3 to 5 business days. Please CHECK your email to complete the next step expeditiously to process your license application.

To apply for a Tennessee School Service license (School Psychology, School Counseling, School Social Worker, and Speech Pathology), please complete and submit this application.

Today's Date

U Number

Full Name

Maiden Name

SSN Number

Date of Birth

Full Address (Street Name, City, State, Zip Code

UofM Email

Personal Email

Phone Number

Race: Check all that apply.

Native American or Native Alaskan
Native Hawaiian / Other Pacific Islander
Asian
White/Caucasian
Black/African American

Ethnicity: Choose One.

Hispanic or Latino
Not Hispanic or Latino

Sex: Please choose one.

Male
Female

Please provide the following information about your bachelor's degree.

Degree Awarded (ex. Bachelor of Arts, Bachelor of Science, etc.)

Degree Major

Degree Conferred Date (ex. December 15 2020)

Institution Name (ex. University of Memphis)

Please provide the following information about your master's degree that you completed.

Degree Awarded (ex. Bachelor of Arts, Bachelor of Science, etc.)

Degree Major

Degree Conferred Date (ex. December 15 2020)

Institution Name (ex. University of Memphis)

Please provide the following information about your start and completion dates of your graduate coursework. Confirm dates on the MyMemphis portal.

Semester start date of your courses (ex. 1/15/2017)

Graduation date or final semester date you completed coursework

Please select the correct endorsement area code(s) for your license.

School Counselor (487)
School Social Work (488)
School Psychology (489)
Speech Language Pathology (498)

Please sign with your full name.

Sign Here

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