Online Services and Forms

The following services can be submitted online with a valid email, and do not require payment:

Service Description Click Link to Access
Change of Name and Address (including employment changes) Board rules require that applicants or licensees report any change in contact information within 30 days of the change.  Name changes require documentation (see directions).

FORM

Clinical Supervisor Registration form Individuals who wish to be added or updated on the Clinical Supervisor Registry, or wish to have their education reviewed for compliance should complete this form and attach required documents. FORM
Complaint Form This form is used for an individual or agency to file a complaint against a licensed practitioner or applicant for licensure.  FORM

The following services can be submitted online with a valid email using a debit/credit card for payment by choosing the SUBMIT ONLINE option.  To submit your request service by mail and pay by cashiers check, money order or personal check (only available for services of $40.00 or less) choose the PRINT PDF option.

Service Description Click Link to Access Fee
Request a duplicate license To request to have an additional copy of an official license sent

SUBMIT ONLINE

PRINT PDF

$25.00
Verification of Licensure (including those needed for other states) Licenses can be verified on the Verifications tab of the Board's website, but if a state seal is required or there are additional forms needed, request a license verification.  You will be provided an opportunity to attach forms for completion.

SUBMIT ONLINE

PRINT PDF

$20.00
Inactive Status Request or Extension to an Inactive Status Request Pursuant to A.A.C. R4-6-305, licensees can request to put their license on inactive status, or request an extension to an inactive status (requires Board approval)

SUBMIT ONLINE

PRINT PDF

$100.00
Public Records Request Records available for public inspection may be requested such as: licensure/application documentation (DO NOT use this option for license verifications, use the Verifications of Licensure service above), meeting audio and a mailing list of licensees. Fee varies by request. 

SUBMIT ONLINE

PRINT PDF

Varies
Investigative Report Request An applicant or licensee who is the subject of an investigation, or their attorney has the ability to request a copy of the investigative report prior to a Board meeting.

SUBMIT ONLINE

PRINT PDF

$25.00 for electronic records
Application Fees Use the SUBMIT ONLINE button to pay your application fee, fingerprint fee, or temporary license application fee by credit/debit card.

SUBMIT ONLINE

Varies
Late Fee If you previously paid your renewal fee or inactive status request fee and were directed to remit a late fee because the request was not submitted timely, click SUBMIT ONLINE to pay by credit/debit card. SUBMIT ONLINE $100.00
License Renewal All renewals require completion of the Arizona Statutes/Regulations Tutorial.  If you have completed the tutorial and wish to submit your renewal online and pay by credit/debit card, use the SUBMIT ONLINE button.  To print and mail your renewal with a cashiers check or money order, use PRINT PDF.  If you have logged your continuing education on the Board CEU tracker(BELOW), you can attach to the online renewal application or print and mail with the .pdf version.

SUBMIT ONLINE

PRINT PDF

$325.00
*NEW
CEU Tracker
The CEU Tracker can be used to log your continuing education throughout your license cycle or for completing prior to starting the renewal application process.  If you are submitting your renewal online, ATTACH the CEU tracker at the spot indicated on the form.  If you are submitting your renewal by mail, print the CEU Tracker and replace the CEU tracking pages in the .pdf.  Please SAVE the CEU Tracker to your local device before completing to avoid losing data.

PRINT or SAVE PDF

CEU TRACKER DIRECTIONS

N/A

The following forms must be submitted to the Board with a personal check (for fees of $40 or less), money order or cashiers check.

Service Description Form Fee
License Synchronization Licensees with multiple licenses issued by AZBBHE may request that their expiration dates be sychronized at the time of renewal of both licenses. PRINT PDF Varies
Rule and Statute Book Order Rule and statute books are available for purchase. PRINT PDF $10.00

Sample client forms - provided for sample purposes only, not required.
       
The following SAMPLE forms include the required elements to meet Board rules: