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License Information

Please select discipline(s) in which you are eligible to be REGISTERED in and wish to practice and apply for licensure: (if practicing in more than one modality MUST have the appropriate registry in EACH modality – ND state law)

Personal Information

Please complete the following information.

(Failure to provide your social security number is a basis to deny a license. Federal law, 42 U.S.C. § 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.)

U.S. Citizen

(8 U.S.C. §1621 requires proof of legal presence in the United States. Acceptable documents include a copy of your birth certificate, or Social Security Card, US passport, foreign VISA or permission to work in the US. A driver's license is NOT an acceptable document to show citizenship. If you have alien status, please contact the Board office for additional acceptable documents.)

Contact Information
Employer Information
Mailing Preference



Page Updated: 5/21/2018 4:18:40 PM