Request for Duplicate Renewal Application

To obtain a duplicate renewal application, please provide the Committee with the information requested below and click "Submit". In most cases, the renewal application will be sent out within 1-2 business days.

If you do not know your license number, go back to the Committee's main web page. Click on "Verify a License". Leave "Profession Name" at All, click on "Licensee Name", and type your name in the text box provided. Make sure you enter your name exactly as it appears on your license. Click the "Search" button. When your record is found, click on "Detail" to obtain the license number.

Name (Last, First Middle)
 
License Number
Select Method of Delivery:
E-mail Address
Mail (we will use the address on file unless a different address is specified below)
Daytime Telephone Number
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