Professional Licensing Agency Forms
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For forms labeled "PDF", the free Adobe Acrobat Reader software is required to view and in some cases fill them out. Forms in other formats (MS Word, MS Excel, etc) are indicated where appropriate.
To open a form once you have chosen it, click on the linked State Form Number (such as 01365.pdf).
For questions about individual forms, please contact this agency's interim forms coordinator, Katie Schulz at 317-234-1982.
For questions about how to use this catalog, or to inform us of a technical problem, please send e-mail to the
Forms marked "read-only" cannot be filled in on your computer. They must be printed out and filled in by hand or typewriter.
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Title |
Form Number |
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Accountancy Application - Part I |
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Admittance for Indiana Funeral Director Examination (read-only) |
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Affidavit - Certificate of Use |
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Affidavit - Completion of Two Hundred Fifty Hours of Barber Instruction |
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Affidavit of Completion of Additional Hours of Instruction |
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Affidavit of Completion of Administrator-in-Training Program (read-only) |
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Affidavit of Completion of One Hundred (100) Hours of Manicuring Instruction (read-only) |
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Affidavit of Completion of One Hundred Fifty (150) Hours of Instructor Training (read-only) |
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Affidavit of Experience - Dietician Intern Training Program |
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Affidavit of Experience - Pharmacist Intern Training Program |
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Affidavit of Supervision - Student Hearing Aid Dealer Certificate |
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Affidavit of Work Experience (read-only) |
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Annual Report of Funeral Trust Funds |
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Annual Report Pursuant to IC 30-2-13 |
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Application For Acceptance of Real Estate College Course Credits (read-only) |
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Application for Activation of a Cosmetology Professional License |
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Application For Activation Of A Land Surveyor - Certificate of Registration (read-only) |
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Application For Activation Of An Inactive CPA/PA/AP License |
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Application for a License to Practice Dentistry or Dental Hygiene |
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Application for a License to Practice Medicine/Osteopathic Medicine in Indiana |
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Application for a License to Practice Veterinary Medicine |
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Application for a Limited License to Participate in a Postgraduate Training Program for Podiatric Medicine |
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Application for Limited License to Practice Nurse-Midwifery |
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Application for a Limited Temporary Permit to Practice Chiropractic |
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Application for a Non-Renewable Limited Scope Temporary Medical License |
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Application for Appraisal Certification by Reciprocity (read-only) |
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Application for Approval of an Individual or Organization to Provide Continuing Education Courses for Dentists and Dental Hygienists (read-only) |
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Application for Approval of a Study Club to Provide Continuing Education Courses (read-only) |
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Application For Approval of Auctioneer Prelicensing Course Provider Or Continuing Education Course Sponsor |
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Application For Approval of Continuing Education Courses for Psychologists |
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Application for Approval of Continuing Education Programs for Chiropractors (read-only) |
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Application for Approval of Continuing Education Programs for Optometrist (read-only) |
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Application For Approval Of Continuing Education Programs For Podiatric Medicine (read-only) |
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Application For Approval Of Continuing Education Programs For Respiratory Care Practitioners (read-only) |
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Application for Approval of Continuing Education Programs for Veterinarians and Veterinary Technicians (read-only) |
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Application For Approval of Cosmetology Educator For Continuing Education (read-only) |
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Application for Approval of Land Surveyor Continuing Education Provider |
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Application for Approval of Plumbing Apprentice School |
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Application For Approval of Professional Supervision For Continuing Education Credit for Psychologists |
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Application For Approval of Real Estate Appraiser Continuing Education Course Provider (read-only) |
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Application for Approval of Real Estate Appraiser School or Course (read-only) |
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Application for Approval of Real Estate Continuing Education Course Sponsor |
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Application for Approval of Real Estate Salesperson/Broker's Course |
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Application For Approval of Real Estate School Site (read-only) |
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Application for Approval to Provide Category I Continuing Education for LSW / LCSW / LMFT / LMHC |
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Application for Approval to Provide Category I Continuing Education for Psychologists |
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Application for Approval to Utilize Electronic Daily Dispensing System |
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Application for Architect Corporation License |
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Application for Architect Examination (read-only) |
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Application for Architect Registration (read-only) |
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Application for a Student Hearing Aid Dealer Certificate |
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Application for a Temporary Medical Permit (For Postgraduate Training or Teaching) |
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Application for Athletic Trainers License |
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Application for Auctioneer License Activation |
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Application for Auction House/Company License |
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Application For Barber Instructor License by Recipocity |
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Application For Barber Professional Temporary Permit (read-only) |
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Application for Barber School License |
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Application for Barber Shop License |
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Application for Boxer License or Renewal of License |
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Application for Cemetery Registration (read-only) |
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Application for Certificate of Authority |
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Application for Certification as an Acupuncture Detox Specialist |
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Application for Certification as a Pharmacy Technician (CPT) |
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Application for Certification as a Physician Assistant |
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Application for Certification as a Respiratory Care Practitioner |
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Application for Certification as an Occupational Therapist or Occupational Therapy Assistant |
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Application for Certification of Engineering Intern (read-only) |
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Application for Certification of Land Surveyor-in-Training |
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Application for Certification to Practice Hypnotism |
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Application for Change or Addition of Supervising Physician for Physician Assistants |
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Application for Chiropractic License |
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Application for Corporate Plumbing Contractor License |
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Application for Cosmetology Continuing Education Instructor |
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Application For Cosmetology Instructor By Reciprocity |
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Application for Cosmetology License by Reciprocity |
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Application For Cosmetology Professional Temporary Permit (read-only) |
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Application for Cosmetology Salon License |
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Application For Cosmetology School License |
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Application For Electrology Salon (read-only) |
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Application for Endorsement as a Health Service Provider in Psychology (HSPP) |
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Application For Esthetic Salon License (read-only) |
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Application for Examination for Auctioneer Licence, License By Reciprocity, or Temporary Permit |
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Application for Examination for Barber Instructor Registration |
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Application for Examination for Beauty Culture Instructor License |
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Application for Examination for Cosmetologist, Manicurist, Esthetician, or Electrology License |
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Application for Examination for Esthetician or Electrologist (read-only) |
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Application For Funeral Director Examination (read-only) |
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Application For Funeral Director Intern License |
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Application For Funeral Home Branch License |
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Application for Funeral Home License (read-only) |
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Application For Funeral Home Restoration (read-only) |
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Application for Health Facility Administrator Provisional License |
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Application for Indiana Controlled Substances Registration (CSR) for Practitioners |
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Application for Indiana Controlled Substances Registration for Non-Practitioners |
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Application for Indiana Dietitian Certification |
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Application for Indiana Intern Training and Experience Record |
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Application For Instructor Approval (read-only) |
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Application For Issuance Of Funeral Director License By Reciprocity (read-only) |
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Application For Journeyman Plumber Examination For Licensing (read-only) |
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Application for Landscape Architect Examination (read-only) |
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Application for Landscape Architect Registration |
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Application for License Activation |
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Application for License or Renewal of License for Trainer, Manager, Matchmaker, or Second |
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Application for License or Renewal of License: Referee, Judge, Timekeeper |
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Application for License to Practice Speech-Language Pathology or Audiology |
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Application for Licensure as a Barber |
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Application for Licensure as a Clinical Social Worker (LCSW) |
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Application for Licensure as a Health Facility Administrator |
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Application for Licensure as a Home Inspector |
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Application for Licensure as a Home Medical Equipment Service Provider |
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Application for Licensure as a Marriage and Family Therapist (LMFT) |
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Application for Licensure as a Mental Health Counselor (LMHC) |
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Application For Licensure As An Acupuncturist/Professional Acupuncturist |
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Application for Licensure as a Physical Therapist or Physical Therapist's Assistant |
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Application for Licensure as a Private Investigator Firm |
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Application for Licensure as a Real Estate Salesperson or Broker |
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Application for Licensure as a Security Guard Agency |
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Application for Licensure as a Social Worker (LSW) |
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Application for Licensure as a Wholesale Drug Distributor |
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Application for Licensure by Endorsement as a Nurse |
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Application for Licensure by Examination for Graduates of Foreign Nursing Schools |
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Application for Licensure by Examination for Graduates of U.S. Nursing Schools |
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Application for Licensure to Practice Psychology in Indiana |
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Application For Manicurist Salon License (read-only) |
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Application for Optometric Legend Drug Certificate |
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Application for Optometry License |
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Application For Or Renewal of Registration as an Apprentice Plumber (read-only) |
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Application For Permit For Nonresident Broker To Act As An Indiana Principal Broker (read-only) |
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Application for Permit to Administer Anesthesia and Sedation (read-only) |
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Application For Permit To Hold Particular Boxing or Sparring Match or Exhibition (read-only) |
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Application for Permit to Operate, Maintain, Open or Establish a Pharmacy in the State of Indiana |
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Application For Permit To Practice Accountancy (read-only) |
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Application for Pharmacist Intern Registration |
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Application for Pharmacist's License |
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Application for Physician License or Renewal of License for Boxing Matches |
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Application for Plumbing Contractor Examination for Licensing (read-only) |
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Application for Podiatry License |
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Application for Prescriptive Authority as an Advanced Practice Nurse |
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Application for Prescriptive Authority for a Physician Assistant |
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Application For Promoter's License To Hold Boxing or Sparring Matches or Exhibitions |
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Application for Reactivation of Appraiser License |
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Application For Real Estate Appraiser Certification |
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Application for Real Estate Appraiser Continuing Education Course |
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Application for Real Estate Appraiser Permit for Temporary Practice (read-only) |
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Application for Real Estate Continuing Education Instructor |
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Application for Real Estate License as a Corporation |
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Application For Real Estate License As A Limited Liability Company (read-only) |
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Application for Real Estate License as Partnership or D/B/A |
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Application for Real Estate Trainee Appraiser Examination/Licensure (read-only) |
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Application for Reassignment of Real Estate License (read-only) |
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Application For Recognition As A Sponsor of Continuing Education |
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Application for Registration as an Environmental Health Specialist |
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Application for Registration as a Non-Resident Pharmacy in the State of Indiana |
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Application for Registration as a Speech-Language Pathology Aide |
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Application for Registration as a Veterinary Technician |
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Application For Registration For Accounting Professional Corporation |
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Application For Registration For Professional Corporation (read-only) |
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Application for Registration for Real Estate Professional Corporation (read-only) |
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Application for Registration for Speech-Language Pathology and Audiology Clinical Fellowship Year |
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Application for Registration of a Mobile Dental Facility (read-only) |
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Application for Registration to Practice as a Land Surveyor (read-only) |
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Application for Registration to Practice Engineering (read-only) |
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Application for Registration Under the Professional Corporation Act |
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Application For Renewal Of A Student Hearing Aid Dealer Certificate |
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Application for Renewal of Certification of Authority and Disclosure and Payment of Prepaid Contracts Sold (read-only) |
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Application for Repeat Examination for Health Facility Administrators |
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Application for Repeat Examination for Hypnotist Certification (read-only) |
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Application For Repeat Examination For Pharmacist License |
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Application for Repeat Examination for Physical Therapists & Physical Therapist's Assistants |
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Application for Repeat Examination for Psychology |
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Application for Sponsorship as a Continuing Education Provider for Health Facility Administrators (read-only) |
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Application for Student Permit to Practice Respiratory Care (read-only) |
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Application for Tanning Facility License (IC 16-41-36, Rule 410 IAC 6-13) |
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Application For Temporary Plumbing Contractor's License (read-only) |
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Application For The Hearing Aid Dealer Examination |
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Application for the North American Veterinary Licensure Examination (NALVE) |
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Application for Transfer of Supervision - Speech-Language Pathology and Audiology Clinical Fellowship Year (read-only) |
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Application for Waiver of Auctioneer Continuing Education |
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Application for Waiver of Continuing Education |
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Application for Waiver of Cosmetology Professional Continuing Education (read-only) |
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Application for Waiver of one (1) Year Real Estate Experience Requirement (read-only) |
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Appointment of Indiana Auctioneer Commission as Agent of Auctioneer to Accept Service of Process or Pleading |
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Appointment of Real Estate Commission of State of Indiana as Agent of Broker or Salesman to Accept Service of Process or Pleading |
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Architect / Landscape Architect Verification of Employment |
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Architect Training and Experience Report (IDP) |
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Authorization to Release Information (read-only) |
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Boxing Score Card (White Judge) (read-only) |
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Case Reports for Funeral Director Intern |
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Certificate in Support of Plumbing Experience Qualifications (read-only) |
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Change in Status and/or Discontinuance of Administrator-in-Training Program |
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Cosmetology Continuing Education Educator Request For Approval Of Additional Courses/Instructors (read-only) |
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Cosmetology Salon Sanitary Rules (read-only) |
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Cosmetology School Sanitary Rules (read-only) |
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Cremation Authority Registration |
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Disclosure and Payment of Prepaid Contracts Sold |
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Electrology Salon Sanitary Rules (read-only) |
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Esthetic Salon Sanitary Rules (read-only) |
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Financial Report of Boxing Promoter |
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Funeral Director Continuing Education Sponsor Request for Approval of Additional Courses (read-only) |
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Health Facility Administrator's Application for Preceptor |
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Indiana Architect Reference (read-only) |
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Indiana Board of Pharmacy Change of Qualifying Pharmacist (read-only) |
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Indiana Board of Pharmacy Continuing Education (C.E.) Application (read-only) |
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Indiana Board of Pharmacy Inspection Report (read-only) |
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Indiana Landscape Architect Reference (read-only) |
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Indiana Occupational Therapy Committee Affirmation of Supervision (read-only) |
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Indiana Real Estate Commission Branch Office Registration |
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Individual Request for Land Surveyor Continuing Education Course Approval (read-only) |
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Letter of Intent - Cosmetology School License (read-only) |
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Manicurist Salon Sanitary Rules (read-only) |
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Monthly Verified Report - Barber School (read-only) |
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Monthly Verified Report- Cosmetology School |
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NCEE Standard Verification-Engineer |
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NCEE Standard Verification - Land Surveyor (read-only) |
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Notice of Intent to Open Buy, Relocate, or Close a School of Barbering |
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Notification of Designated Licensed Plumbing Contractor For Licensed Corporate Plumbing Contractor (read-only) |
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Notification of Designated Trustee (read-only) |
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Physical Therapy Committee Affirmation of Supervision (read-only) |
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Professional Engineer or Land Surveyor Roster Listing (read-only) |
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Professional Licensing Agency Comment Card (read-only) |
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Provider Request for Approval of Additional Land Surveyor Continuing Education Courses/Instructors (read-only) |
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Questionnaire on Applicant Reference for Professional Engineers (read-only) |
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Real Estate Continuing Education Sponsor - Request for Approval of Significant Change(s) (read-only) |
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Record of Store Closing (read-only) |
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Reference for Registration As A Professional Engineer (read-only) |
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Reference Sheet For Registration As Land Surveyor-In-Training (read-only) |
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Registration of Auctioneer Doing Business As (DBA) |
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Report of Employee Attendance for Professional Engineers and Land Surveyors Exam (read-only) |
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Report of Injury/Complaint of Injury |
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Report of Intern Periodic Assessment (read-only) |
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Report of Physician |
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Report of Tanning Facility Inspection |
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Request for Change of Name, Address, or Duplicate License (read-only) |
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Request for Issuance/Transfer of Indiana Trainee Appraiser License (read-only) |
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Request for Waiver of Six Month Experience Requirement to Manage a Salon |
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Roster Listing-Architect and Landscape Architect |
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Seller's Residential Real Estate Sales Disclosure (read-only) |
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Start Notification for Administrator-in-Training Program for Health Facility Administrator (read-only) |
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Supplemental Information for Land Surveyors Application |
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Supplemental Information for Land Surveyors in Training Application |
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Supplemental Information for Professional Engineer and Engineer in Training (EIT) Application |
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Surety Bond (read-only) |
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Surety Bond (Appraisers) (read-only) |
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Verification of Administrator-In-Training Program for Health Facility Administrator Licensure |
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Verification of Employment for Registration as Land Surveyor (read-only) |
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Verification of Employment of Applicants for Health Facility Administrators Licensure (read-only) |
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Verification Of Reference For Registration As Land Surveyor (read-only) |
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Verification of State Licensure |
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Verified Complaint Requesting Restitution From the Preneed Consumer Protection Fund (read-only) |
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- How do I find the state form I need?
- What kind of records can I find in the Indiana State Archives?
- How can I obtain copies of state records?
- How do I order copies of records from the Indiana State Archives?
- How long must a state or local government agency keep its records?
- How should a state agency transfer records to the State Records Center for stora...
- Browse the State Archives Collections
- Find a State Form
- Learn How Long My Agency Must Keep Records
- Find the Records or Forms Coordinator For My Agency
- Microfilm or Image My Agency's Records
- Send My Agency's Records to the Records Center
- Send My Agency's Records to the State Archives
- Prevent or Report a Public Records Emergency
- Arrange a Tour or Attend a Training Session
