Renewals, name changes, and other actions

Links and forms to renew, change information, and request documents for individuals may be found here

Table of Contents

Request a Verification of Licensure

Provides official verification of a Board license or registration and is often required when seeking licensure in another state.

  • Can be downloaded immediately and for free from
  • If either the downloaded version is not acceptable to the recipient or an out-of-state verification form requires Board completion, complete the online application and provide the $15 non-refundable and non-transferable fee. (There will be a $23 handling charge for returned checks.)

Social Security Number or Date of Birth Update

What you need:

  • Notarized affidavit to confirm your social security number and date of birth (this form can be found in the online application).
  • For a new social security number: copy of Social Security Card or certified copy of documentation showing authorization for the assignment of a different social security number from the Social Security Administration or a court of law.
  • For an incorrect social security number: copy of Social Security Card. If you don't have a card, you can use a recent tax return or W-2 from the last three years.
  • Incorrect date of birth: copy of birth certificate or a current government-issued photo ID that has your date of birth (e.g., passport, driver’s license).

Name Changes

What you need:

  • $27 non-refundable and non-transferable fee (There will be a $23 handling charge for returned checks.)

Supporting documents such as marriage certificate, divorce decree, or other court documents to be added to the online application.

Help Us Improve  with your feedback

Please do not include personal or contact information.