Forms

PAYMENT FOR INITIAL APPLICATIONS MUST BE MADE BY MONEY ORDER OR CASHIER'S CHECK.  PRACTICE IS PROHIBITED BY LAW PRIOR TO ISSUANCE OF A LICENSE. APPLICANTS ARE URGED TO NOT ENTER INTO IRREVOCABLE CONTRACTS, PURCHASE, OR SALES AGREEMENTS ON THE ASSUMPTION THAT LICENSURE WILL BE GRANTED.

There are a variety of forms required for different licensing actions.  Below, by category, are the forms you will need to complete for each type of action:

INITIAL APPLICATION - first time submission

• Initial Application Please read the statement regarding disclosure of criminal history prior to completing your application.

• Professional Recommendation Form (2 are required)
• Arizona Statement of Citizenship (including document for proof of citizenship)List of Acceptable Documents for Proof of Citizenship
• Verification of Licensure from Other States

In addition, you will need to have the National Board for Certification in Occupational Therapy (NBCOT) provide verification of your passing the board exam.  The following is the link to their website where you will find the information you need to accomplish this part of the application process.

• NBCOT Verification

Finally, you will need to submit your fingerprints.  The Board does not accept Fingerprint Clearance Cards.  Fingerprints can be done at most any police station.   Below are instructions for having your fingerprints done.  These instructions include a sample of the fingerprint card.  DO NOT use this sample in place of an actual card.

• Fingerprinting Instruction Form

LIMITED PERMITS

If an individual has completed their school requirement but has not yet taken their NBCOT exam, they may apply for a limited permit.  In order to obtain a limited permit all of the documents listed above for the initial application must be submitted.  In addition the following documents must be included:

• An official transcript from the educational institution issuing the degree or an official letter of completion on the educational institution's letterhead.
• Direct Supervision Form

RENEWAL APPLICATION  

 

As such, we are requesting that you sign the positive affirmation, included in the renewal section of the application below, certifying that nothing has changed with regard to your citizenship or right to work status.

• Renewal Application
• Arizona Statement of Citizenship (If you have previously submitted documentation of your citizenship or right to work in the United States and if nothing regarding that information has changed then you will not be required to resubmit the information.)
• List of Acceptable Documents for Proof of  Citizenship
• Continuing Education - See Continuing Education for details but be sure to provide copies that verify attendance at the continuing education event.

PAYMENT FOR RENEWALS CAN BE MADE BY CASH (DO NOT MAIL CASH), CHECK, MONEY ORDER OR CASHIER'S CHECK

OTHER RELATED FORMS

If you need the Board to verify your Arizona License to another state please use the following form to submit your request:

• Verification of Arizona License
• Change of Address, Name or Employer
• Request for Public Record (to include mailing lists)
• Public Record Statute
• Small Business Bill of Rights
• Fee Waiver Application