REQUEST FOR DUPLICATE RENEWAL APPLICATION

To obtain a renewal application, please provide the state board with the information requested below and click submit.

Note: If you do not know your license number, go to the board's main web page and click on LICENSEE SEARCH on the sub navigation. Leave the County Name and Profession Name fields set to ALL. Click on Licensee or Practitioner DBA Name and type your name in the text box provided. Be sure to enter your name specifically as requested (ie, Doe, John). Click the SEARCH button. When your license record is found, click on DETAIL to obtain the license number.

 

NOTE: ALL RENEWAL APPLICATIONS WILL BE SENT OUT IN THE FOLLOWING ORDER BASED INFORMATION PROVIDED: EMAILED TO THE EMAIL ADDRESS IF NO EMAIL IS PROVIDED, THE FORM WILL BE FAXED TO NUMBER PROVIDED. IF NEITHER ARE PROVIDED, THE FORM WILL BE MAILED TO THE ADDRESS PROVIDED.