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Relicensure Forms

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The following items are required as part of your submission to the Relicensure Committee.

All items must be submitted via email (as one single PDF file) to or via fax (as one complete fax) to 651-789-3093.

Materials must be in the order listed below for your file to be reviewed by the Committee:

  • Relicensure Submission Cover Sheet
  • Copy of Current License
  • License History (under License Lookup, enter your file folder number and click "Details")
  • Relicensure Master Record Form
  • CEU Documentation

Once your relicensure application materials have been submitted electronically, please submit your Relicensure Application Review Fee payment on our webpage here.

While these forms are printable, it is recommended that you completed all forms on your computer.

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