REACTIVATION APPLICATION - Found on the board’s web-site under the link for Download Forms.
NOTARIZED APPLICATION, $250 FEE and PHOTOGRAPH taken within last year. Any question answered “yes”, requires further documentation to be submitted. Attach an explanation if you have had any criminal convictions or charges, or sanctions by another state licensing board. The Board, at their next scheduled meeting, will review the application with required documentation. Approval of licensure is at the Board’s discretion.
OTHER STATE LICENSURE CERTIFICATION: If you are or have ever been licensed in another State(s), please have that/those State(s) officially certify that license directly to the Board’s office.
RESUME OR CV - List chronologically all employment, specialty training and all other experiences in the practice of chiropractic. Include names, beginning and ending dates, and locations, where applicable. Explain any intervals where you were not in training or practicing chiropractic.