Personal Information

Please provide your information below.

(Failure to provide your social security number is a basis to deny a license. Federal law, 42 U.S.C. ยง 666(a)(13)(A), requires state professional and occupational licensing authorities to obtain all applicants' social security numbers and report these numbers to the state's child support enforcement authority. We will keep your social security number confidential, except when required to provide it according to state or federal law.)

Do you currently hold one of the eligible licenses?

Per NDAC 114-02-01-02(3), the eligible licenses include: Medical technologist, medical laboratory technician, or clinical laboratory technician; Occupational therapist or occupational therapy assistant; Physical therapist or physical therapy assistant; Physician assistant or orthopedic physician assistant; or Registered nurse or licensed practical nurse.




Page Updated: 4/24/2023 1:20:26 PM