Get License Roster Request Form - Division Of Professional Regulation ...

This guide will assist you in completing the License Roster Request Form from the Division of Professional Regulation. Following these step-by-step instructions will ensure that you provide all necessary information accurately and efficiently.

Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin by checking each profession for which you are requesting a roster. The form includes various categories such as accountancy, nursing, and mental health. Ensure you select all relevant professions, as all active licenses under the jurisdiction of the selected professions will be included.
3. Next, enter your requester information in the designated fields. This includes providing your organization name, contact person’s name, contact address, and phone number. Ensure accuracy to avoid delays in processing.
4. Importantly, enter the email address to which the roster should be sent. Make sure that this email is valid to receive the roster promptly.
5. Finally, include payment of $40.00 for each profession box you checked. Calculate your total payment based on the number of boxes selected and ensure the payment is enclosed with your form submission.
6. Once you have completed all sections and verified the information, save any changes you made to the form. You can then download, print, or share the completed form as needed.

Complete the License Roster Request Form online today to access important licensing information.