Reinstatement from Inactive/Retired
Use this form if you wish to reinstate or reactivate your license/certificate that currently displays a status and sub-status of Inactive/Retired.
Reinstatement from Inactive/Not Practicing
Use this form if you wish to reinstate or reactivate your license/certificate that currently displays a status and sub-status of Inactive/Not Practicing.
Retire a PT License or PTA Certificate
If you wish to retire your AZ license or certificate, complete this form and upload to a "retire" service request through your eLicensing portal. NOTE, retiring a license/certificate indicates you are no longer working as a PT/PTA in AZ or elsewhere.
Inactivate a PT License or PTA Certificate
If you wish to inactivate your AZ license or certificate, complete this form and upload to an inactivation service request through your eLicensing portal.
Arizona Statement of Citizenship and Alien Status Form
This form must be completed in its entirety by every applicant for PT licensure or PTA certification. Upload the completed form to your application through the eLicensing system.
ADA Accommodations For Testing
This form must be completed by those applicants seeking ADA Accommodations for the NPTE and/or AZLAW exams. Upload the completed form to your application and submit via the eLicensing system.
Required Reinstatement Documents
Please complete the forms and upload the appropriate documents into the eLicensing System.
Dry Needling Training Submission Form
Use this form to submit completion documents demonstrating compliance with the rules for Dry Needling training and education.
Continuing Competence Audit Form
Licensees and certificate holders may use this form to independently track their own continuing competence activities. If audited, this form is to be downloaded and submitted electronically, with all associated continuing competence certificates of completion, to the Board office. Licensees and certificate holders selected for continuing competence audit will be noticed via certified mail.