Get Fl Dh-mqa 1175 2013-2025

This guide provides a clear and supportive approach to completing the FL DH-MQA 1175 intern registration application online. By following the steps outlined below, users can accurately fill out the form and ensure they meet all necessary requirements.

Follow the steps to accurately complete your intern registration application

1. Click ‘Get Form’ button to access the FL DH-MQA 1175 document and open it in the online editor.
2. Begin with Section I - General Information. Select the registration category you are applying for by checking the appropriate box. Provide your legal name, mailing address, practice location address, and contact numbers. If you prefer not to display your mailing address publicly, ensure that you fill in the practice location address as desired.
3. In Section II - Post-Secondary Education Background, list your degrees starting from the master’s level, along with the institution names, and the dates you received your degrees.
4. Proceed to Section III - Qualified Supervisor(s). List the names of your qualified supervisors, their license titles, Florida license numbers, and the years they received their licenses. Attach letters from each supervisor confirming their agreement to supervise you as an intern.
5. Section IV - Applicant History – General requires you to disclose any prior convictions or legal issues. If applicable, provide details and certified court records.
6. In Section V - Applicant History – Professional, answer questions regarding any past license denials or disciplinary actions, providing detailed explanations as needed.
7. For Section VI, disclose any felony convictions pursuant to Section 456.0635. Make sure to provide supporting documentation if needed.
8. In Section VII - Certification, carefully read the certification statement. After signing and dating the form, ensure that you include your social security number in Section VIII.
9. In Section IX - Applicant History – Health, respond to questions regarding your mental and physical health status that may affect your ability to practice.
10. Once all sections are completed, review your application for accuracy. Save your changes, download the completed form, and decide whether to print or share it.

Complete your FL DH-MQA 1175 intern registration application online today to take the next step in your professional development.