Follow the steps to fill out your application with confidence.

1. Click the ‘Get Form’ button to access the application form and open it in your preferred editing software.
2. Begin by reviewing the fee waiver section. If you qualify under any of the listed categories—young worker, low-income individual, or military family—check the corresponding box to have your application fee waived. Ensure you have the necessary documentation to support your claim.
3. Proceed to Section A: Information. Fill in your legal name, any other names you've been known by, and your contact information. Include your Social Security Number and date of birth accurately, as these are required fields.
4. In Section B: Methods of Licensure, select your method of applying for licensure. Check the box that corresponds with your qualifications, ensuring you provide required documentation, such as proof of education and examination results if applicable.
5. Move to Section C: Conviction and Licensure Information. Answer all questions truthfully regarding past convictions or disciplinary actions, including details and documentation as necessary. Incomplete information may delay your application.
6. In Section D, confirm whether you have practiced perfusion in Nebraska without a license. Ensure to input correct details if applicable, including the number of days and business information.
7. Finally, review Section E: Attestation. Check the appropriate box regarding your citizenship status and ensure you sign and date the application. This attestation confirms that all information provided is true and complete.
8. Once you have completed all sections, review the form for accuracy. Save changes, download a copy for your records, and prepare to submit the application along with required documents and payment to the Licensure Unit.

Complete your application today to move forward with your professional licensing!