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Click ‘Get Form’ to open the Disciplinary Actions Disclosure in the editor.
Begin by carefully reading the introduction section, which outlines the importance of disclosing any misdemeanor or felony convictions since your last license renewal.
Proceed to Section 1, where you will answer questions regarding any professional licenses that have been denied, suspended, or revoked. Select 'YES' or 'NO' for each question.
Continue through Sections 2 to 15, providing truthful answers about any disciplinary actions, judgments, or convictions. Ensure you check all relevant boxes as required.
If you answered 'YES' to any questions in Sections 1 through 14, complete the follow-up questions regarding previous disclosures and provide approximate dates.
Finally, review your responses for accuracy and completeness before signing and dating the form at the bottom.
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