Licensure application 2026

1. Click ‘Get Form’ to open the Duplicate or Replacement Certificate of Licensure Application Form in the editor.
2. Begin with Section 1, where you will enter your MIRTP Registration Number, which is essential for identification. Fill in your personal details including Name, Address, Phone Numbers, and Email.
3. In Section 2, check the box if you are requesting a replacement certificate. This indicates your need for an additional license type.
4. Proceed to Section 3 to provide information about your active credentials. Enter all applicable ID numbers and credentials from recognized organizations like ARDMS or ARRT.
5. Review the Fee Schedule in Section 4. Calculate your total fee based on the number of certificates requested and ensure it aligns with the payment method selected in Section 5.
6. Complete Section 6 by checking off each item as you finalize your application packet. Ensure that all required documents are included before submission.
7. Finally, sign and date the form in Section 7 to certify that all information is accurate and complete.

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