Other Forms and Information


1051SSN Exempt Form (Only applicable if applying to obtain or renew​ a credential and you do not have a Social Security Number.)
Upload completed form into your LicensE application.
2252​Convictions and Pending Charges
1229​Communicable Disease Form (Only applicable to Health Professions)
​Application for Initial Credential Fee Reduction (Optional)
3085​Application for Predetermination (Optional)
3071​Payment Form​
3082​Wall Certificate with Wallet Card or Governor-Signed Wall Certificate Request Form
​LicCo​unts​​Monthly License Counts


Disability Modification Request Form for Examinations
2349​Requests for Modification of Examinations for Persons With Disabilities
2350​Professional Verification of Request for Modification
Military Licensure Benefits​Military Benefits Related to Licensure for Eligible Veterans, Service Members, and Spouses
Death of a Licensee​Procedure for Reporting the Death of a Licensee