First we will need to collect the information necessary to begin your application.

Identity Information
First Name is required.
Middle Name or Initial is optional.
Last Name is required.
For example enter Jan 2, 1970 as: 01/02/1970
Please enter your Social Security Number
Please enter your Social Security Number again to confirm accuracy

 

For assistance please call the licensure office at 501-682-4342 Monday through Friday between the hours of 7:30AM – 4:30PM.


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