Licensing & Certification » Health Occupations Credentialing

Applications & Forms

Education

• Instructor Application
• Waiver Application

Universal Forms

• Credit Card Authorization
• Name or Address Change

Nurse Aide

• Accommodation Request Form
• Allied Health Form
• Documentation of Training for Challenging Test
• Employment Verification
• Interstate Application Form
• Rescheduling Exam Request

Home Health Aide

• Accomodation Request Form
• Allied Application
• Document of Training for Challenging Exam
• Employment Verification
• Reschedule Form
• Trainee II Document of Competency for Employment

Medication Aide

• Accomodation Request Form
• Document of Training for Nursing Students

Adult Care Home Administrator

• AIT Program App for AIT Coordinators
• Initial License Application
• Notice of Training and Request for Practicum and Preceptor Approval
• Pocket Card-Wall Certificate Request
• Preceptor Application
• Reciprocal Application
• Reference Letter Form
• Reinstatement Application
• Temporary License Application

Dietitian

• Application Pack
• Pocket Card-Wall Certificate Request
• Reinstatement Application

Operator

• Application Pack
• Criminal Record Check Form
• Operator Prorated Licensure Fees
• Pocket Card-Wall Certificate Request
• Reinstatement Application

Speech Language Pathologist/Audiologist

• Application Pack
• Assistant Reporting Form
• Pocket Card-Wall Certificate Request
• Postgraduate Professional Experience Plan
• Postgraduate Professional Experience Plan Documentation
• Reinstatement Application