Verification of Licensure Form 2026

1. Click ‘Get Form’ to open the Verification of Licensure Form in our platform's editor.
2. Begin by filling in your name clearly in the designated fields for Last, First, Middle, and Maiden names.
3. Next, provide your complete address including Street/P.O. Box, Apartment/Floor number, Town/City, State, Zip Code, and Country.
4. Enter your Social Security Number and Date of Birth. If you do not have a Social Security Number, please fill in your Passport Number.
5. Input your License # or Application # in the specified field.
6. Authorize the Vermont Secretary of State by providing the address and name of the Licensing Authority where the information will be sent.
7. Finally, sign and date the form at the bottom to complete your application.

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