Request for Bureau of Professional Licensing Assistance

Agency: Licensing and Regulatory Affairs

     

Bureau of Professional Licensing Assistance Request Form

Please provide as much information and detail as possible as it pertains to your request for assistance. Inquires are answered in the order they are received, and a complete form ensures an accurate and timely response.

 

Name: 

 

Case # 

 (Optional)

License #

 (Optional)

File #

 (Optional)

Application #

 (Optional)

License Type

Address

 

City/State/Zip 

   

Email: 

 

Telephone: 

 

Please Explain the Issue:

 

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