Please select the discipline in which you are eligible to be registered in and wish to apply for licensure. If you select other you must contact the Board office prior to submitting the application.
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. 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.)
If "yes", you must submit proof of active member status. Appropriate proof is a military issued ID.
If "yes", you must submit proof of a spouse of active member status. Appropriate proof are a military issued ID noting relationship to the military member and the orders of the active military member spouse.**As defined in NDCC 43-51-01(5), a military spouse is one who is currently licensed in another state or jurisdiction and who is the spouse of a member of the armed forces of the United States or a reserve component of the armed forces of the United States stationed in this state in accordance with military orders or stationed in this state before a temporary assignment to duties outside of this state.
Please provide your mailing address information below. (This is the mailing address where the Board office will send your Criminal History background check forms and eventually your license.)NOTE: The county dropdown only lists counties in North Dakota. If you live outside of the state, please select Out of State in the alphabetical list.
Please only complete this section if you are employed as an Imaging Professional. If you are not currently employed, this section can be provided at a later date by using the online Licensee Dashboard.
