Reactivation Application
Complete the fillable reactivation application below. Print sign and upload a copy of the completed application below along with all supporting documentation.
The reactivation fee can be paid via credit card using the link below. Please upload a copy of the receipt once paid. The current total reactivation fee is: $246 ($170 license fee, $50 reactivation fee, $26 Health Care Commission fee)
Name Change: If there has been a change in name please submit the Name Change Form and relevant documents (do not send the $5.00 duplicate license fee)
Submission of Continuing Education documentation is required to reactivate a license. If a license has been in a non-renewed (expired) status for less than two years a reinstatement candidate must submit 30 hours of continuing education completed during the period of inactivity. If a license has been in a non-renewed (expired) status for more than two years but less than five years, the reinstatement candidate must submit evidence of a total of 30 hours of continuing education completed during each two-year cycle of inactivity, not to exceed 100 hours. Continuing education completion certificates can be uploaded via pdf format below. Administrative Requirements (must be met for reinstatement) Continuing Education: Must submit documented proof (legible copies) of satisfactory completion of at least 30 hours, completed during the time of inactivity, if reinstating within two years of expiration date, or 30 hours per each two-year cycle of inactivity (not to exceed 100 hours) completed during the time of inactivity, if reinstating more than two years and not more than five years since the expiration date of the license.
Reapplying for a License: A license that has been expired for more than five years, is not eligible for reinstatement. The individual must re-apply for a license and meet or exceed all minimum requirements currently in effect at that time.
Verification of Good Standing: Documented proof (original/sealed/signed certificate or letter) from the State Board of any state in which you are or have practiced, attesting to good, active practice with no disciplinary history, is required.
Effective October 1, 2016 all licensees and applicants are required to complete a Criminal History Records Check which can be located on the Board's website.