Begin Main Content Area

Applications and forms

Application types 

Initial Licensure Applications

Reactivation Applications *

(*Expired or inactive licenses)



Name and/or Address Change (Address change can be made online)

Radiology Authorization Name and/or Address Change (with or without a request for a duplicate)

Verification of licensure to another state - request ONLINE

NOTE:  As a result of document fraud and in an effort to protect its licensees, the Board will only provide direct source verification of your license to another state licensing agency.