Request for Completion of Licensure Form

What is it?

Use this to request state licensure form to be completed.

Who is Eligible to use it?

Alumni and Credentialing Services

Service Pre-requisites

Access to the state licensure form (including address for form submission)

Service Availability

Monday to Friday - 8:30 am to 5 pm

Service Level Agreement

7 Business Days.




Submit Form


Service ID: 142
Thu 2/17/22 5:01 PM
Mon 2/20/23 12:15 PM