Apply for a limited respiratory therapist license

• Social Security Number SSN
• Date and place of birth
• Mother's maiden name
• 2x2 passport style color photo with a white or off-white background
  • Copies and printer generated photos are not acceptable
• A notary signature
• Completed Verification of Education form, found in the in application
• Request that the following documentation be sent to the Board:
  • Transcripts from any post-secondary schools or programs that you have attended and/or completed/graduated or are currently attending. When requesting transcripts, please inform each school’s registrar that the transcript must be complete and indicate the degree/certificate and date conferred in mm/dd/yyyy format, if applicable.
  • Verification of licensure status, in signed, sealed envelopes, from any state or jurisdiction in which you now or have ever held any professional license or board certification. Verifications must be sent directly to the Board by the state or other jurisdiction.
    • Note: All documents must be received by the Board in signed, sealed envelopes
• National Board of Respiratory Care (NBRC) documentation of certification. The verification must be sent directly to the Board; email, online, and other verifications are not acceptable. You must have obtained a passing score on NBRC’s CCRT examination.
• Verification of licensure status, in signed, sealed envelopes, from any state or jurisdiction in which you now or have previously held any professional license or board certification. The state or other jurisdictions must send verifications directly to the Board.
  • Note: If verifications have been previously submitted with an application for a limited permit, you don't need to submit them again if they were issued within the past 12 months
• Submission of the Criminal Offender Record Information Request Form (CORI), found below

If applicable

• If you hold, or have ever held, any professional license, you must request and submit a National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank Self-Query. To request a Self-Query, please contact the National Practitioner Data Bank. Include the original report with this application. Make a copy for your records.
  • Note A: If you don't hold and have never held any professional licenses in any other state or jurisdiction, you don't need to submit a National Practitioner Data Bank self-query
• If you answer "yes" to any of the questions 12-17:
  • Attach a separate sheet explaining the circumstances

The address printed on your license is a public record that is available to anyone who requests it. If you are using your home address, you may wish to consider changing this to an office address. You may request address changes online at the board’s website, or you may get a form online to submit to the Board’s office.