Verification Of Experience Form - California Board Of Psychology Page 3
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3Collection and Use of Personal Information
The Department of Consumer Affairs and the California Board of Psychology collect the information requested
on this form as authorized by Business and Professions Code sections 325 and 326 and the Information
Practices Act.
Access to Your Information
You may review the records maintained by the California Board of Psychology that contain your personal
information, as permitted by the Information Practices Act. See contact information below.
Possible Disclosure of Personal Information
We make every effort to protect the personal information you provide us. However, we may need to share the
information you give us with other government agencies. This may include sharing any personal information
you gave us.
The information you provide may also be disclosed in the following circumstances:
•
In response to a Public Records Act request, as allowed by the Information Practices Act;
•
To another government agency as required by State or Federal law; or
•
In response to a court or administrative order, a subpoena, or a search warrant.
Contact Information
For questions about this notice or access to your records, you may contact the California Board of Psychology,
1625 North Market Boulevard, Suite N-215, Sacramento, CA 95834; by phone at (866) 503-3221; or by e-mail at
bopmail@dca.ca.gov. For questions about the Department’s Privacy Policy, you may contact the Department
of Consumer Affairs at 1625 North Market Boulevard, Sacramento, CA 95834; by phone at (800) 952-5210; or
by e-mail at dca@dca.ca.gov.
(Revised 3/15)
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