Letter of intent form 2026

1. Click ‘Get Form’ to open the Letter of Intent in the editor.
2. Begin by filling out the 'Provider Information' section. Ensure all required fields marked with an asterisk (*) are completed, including your name, mailing address, and date of birth.
3. In the 'Referral Information' section, indicate your licensed discipline if applicable. Select any foreign languages you speak fluently and specify counties where services will be provided.
4. Complete the 'Location Information' section by providing details about where services will be delivered. Ensure that this site is handicap accessible.
5. Fill out the 'Education Information' section with your educational background, including institutions attended and degrees earned.
6. In the 'License/Certification Information' section, list all relevant licenses held in the past ten years along with their status.
7. Provide your work history in detail, ensuring to explain any gaps in employment on a separate sheet if necessary.
8. Finally, review and sign the attestation statement to certify that all information is accurate before submitting your application.

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