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Application for Licensure
Section I

There is a filing fee of $150.00.

General Information

Legal Name(s) Only

If no legal middle name, enter "none"

 Your information is secure and required for our records

Contact Information for all Official Board Correspondence

If using a business address

If Military Address, please enter APO or FPO

If Military Address, please select AA, AE, or AP

If you are requesting reinstatement, you must complete a Reinstatement Affidavit. All applicants with inactive licenses must also submit delinquent continuing education of 24 hours; of those, at least 16 must address the safeguarding of life, health, and property. At least one professional development hour must be directly related to ethical issues of professional practice (use the CE Log on our website).

If you have an NCARB certificate, request NCARB to transmit it directly to the Board.