List of Licenses Request Form

List of Licensees Form
     Fee: $20/Request

2018-2019 Renewal Information

Licensure Renewal Form
     Fee: $300

Licensure Application Forms

Application for Licensure
     Fee: Dependent on date application is submitted. Please read form for correct amount.

Letter of Reference
     submit with initial licensure application

Licensure Examination Application

Licensure Exam Forms

Private Practice Forms

Clinical Supervisor Forms

Clinical Supervisor Application
    Fee: No Fee to Apply

Clinical Training Forms

Clinical Training Admission Application
     submit to Training Consortium

Clinical Trainee Registration Form
     submit to ND BACE

Clinical Training Program Application
 
    submit to Training Consortium, with the admission application form

Clinical Training Completion Form
 
    submit to ND BACE

Individual Training Plan Request Form
 
    submit to ND BACE

Continuing Education Forms

Continuing Education Guidelines
     for your records, do not submit

Continuing Education Record of Attendance
     for your records, do not submit

Approved Provider Status
     Fee: $100/Provider

Approved Program Status
     Fee: $35/Program

Complaint Forms

Complaint Form
     submit to ND BACE

Complaint Process

Consortium Resources

Clinical Trainee Completion Form
     Submit to ND BACE

Trainee Interview Questions
 
    for your reference, do not submit to ND BACE

Internship Registration Form
 
    submit to ND BACE

Letter of Reference Form
    applicant submits to ND BACE with license application

Letter of Reference Guidelines
    for your reference, do not submit to ND BACE

Licensure Forms

forms