Other Forms and Information

​​​​​ AccessGov Logo

We have transitioned our forms to a new, online platform, AccessGov, which meets Americans with Disabilities Act (ADA) guidance. For many forms, the only difference will be appearance, while others may have more noticeable differences. Please review the directions on each form for guidance and take a minute to read this FAQ about AccessGov: AccessGov_QandA.pdf.​​


​​​​​​​Forms

FormDescription
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)
​​3217
​Application for Initial Credential Fee Reduction (Optional)
​​3071​Payment Form​
​3082​Wall Certificate with Wallet Card or Governor-Signed Wall Certificate Request Form
​LicCo​unts​​Monthly License Counts

Information

TitleDescription
​1907
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
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