Inactive Status Request Form

A fee of $25.00 is required to transfer into an inactive status. Please note that upon Board approval, the licensee will remain in inactive status for two years. You will receive a notice 60 days prior to the expiration of your inactive status, with instructions on how to renew your inactive status or how to reinstate you license.


Please submit the request form with your payment via credit card using the link below.


Once paid please upload a copy of your receipt and check the box below. Please use the link below to print and sign the inactive status request form.


Inactive Status Request Form


Frequently Asked Questions

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A fee of $25.00 is required to transfer into an inactive status. Please submit payment via credit card using the link below. Once paid please upload a copy of your receipt and check the box below.


Submit Payment

1) Scan and upload a signed and completed request form.


2) Receipt of payment for replacement license.

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