Board of PodiatryDivision of Occupational and 2025

1. Click ‘Get Form’ to open the application in the editor.
2. Begin by selecting whether you are applying for Licensure by Exam or Licensure by Endorsement. This choice will guide the rest of your application process.
3. Fill in your full name, address of record, mailing address, and date of birth. Ensure that all information is accurate as it will be used for public records.
4. Enter your Social Security number. Remember, this is not a public record but is required for processing your application.
5. Complete sections regarding your education, including collegiate education and podiatric medicine degree. Attach certified copies of transcripts directly from the institutions.
6. Provide details about your residency program and ensure proof is sent directly from the accredited program to avoid delays.
7. Answer questions regarding previous licensure, criminal history, and moral character references honestly. Attach any necessary documentation as specified.
8. Finally, ensure your signature is notarized before submitting the completed form along with the required fees to the provided address.

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