CHANGE IN STATUS Details

Obtaining the Registration

Ready to get your registration? - Steps, Requirements, and Documents

1. Check one or more of the options on the form.

2. Complete name, Certificate No., category(ies), Social security number, New Business License/Agency No., Bus./Agency Telephone No., Email Address, New Business/Agency Name, and Address.

3. Effective date of change.

4. Name and telephone number of immediate supervisor.

5. Give former employer’s name, address and telephone number.

6. Previous home address.

7. List your current home address.

8. You must attend a recertification training session each year between July 1 and June 30. List the name, date and location of training session you attended during the last license year.

9. Signature of Applicant and date is required.