Application for Licensure - Personal Information

Please create a password that you will use going forward to log in to all online forms including: updating your personal/employment information, printing your license, future renewal forms, etc.

Passwords must be at least 8 (eight) characters in length and include at least 1 (one) uppercase letter, lowercase letter, number and special character.
Special characters allowed are: ! $ % & * ( ) - [ ] { } , / : ?