Other Forms and Information

​​​​​​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)
​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

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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