Online Form Submission

Step 1

  1. Download form(s) from our Forms page.
  2. Fill out form using intructions included in the form
  3. SAVE!!!! the form before uploading



Please indicate purpose of fee and legal name of applicant below. Thank you

Step 2

  1. Email your forms using the email forms button below or using the information below in an email client.
    1. Email to:
    2. Subject:
Email Form

Step 3

Select correct fee(s) for the uploaded forms then click Pay Now OR click Submit Forms to submit forms that do not require a fee.

Qty Fee
$150 Licensure Application
$300 2018-2019 Licensure Renewal
$50 Examination Application
$200 Private Practice Application
$250 Approved Provider
$50 Approved Program
$75 LCAC Grandfather
$75 LMAC License Application
$50 List of Licensees

Online Transaction Fee Learn More

Paypal Transaction Fee

The Paypal transaction fee is the direct cost for processing an online payment. If you wish to skip this fee please mail your payment by check to 402 E MAIN AVE, Ste #5, Bismarck, ND 58501-4091