Forms and Applications

​Filling out forms and applications is an important part of the respiratory care licensure procedure. The KBRC expects all questions answered completely and accurately. Always check your forms and applications to make sure nothing has been left blank. Failure to complete a document or answer a question will result in the application being returned to you.

Important information regarding regulations and fee changes.
Please read carefully.

Fee Changes 2016.pdfFee Changes 2016.pdf

Applications

The procedures for licensure that follow are designed to protect the individual as well as the facility from liability that could arise from someone being on staff without proper license which could result in fines for both the individual and the facility.
  
$60.00 Limited Mandatory or Student License is required for those students who intend to work while in school. It is a 3yr. license that expires once the individual graduates. All remaining time of Student License will expire. To continue working, individuals must apply immediately for a Temporary License with the KBRC.
 
$102.00 Temporary License is a 6 month license based from the date of graduation or until the individual passes the NBRC credentialing exam. Proof of graduation must be sent to receive the license. Once the individual has passed the NBRC, the remainder of the 6 months will expire and the individual must immediately update to the final application for Mandatory License with the KBRC.
 
$150.00 Mandatory License  This is the final process for the individual to become a fully licensed respiratory therapist. Once a person has passed the CRT exam, the individual must send a copy of the test score together with the application for a Mandatory License and appropriate payment. The new therapist will receive a license number and license information. The new therapist must renew the license every 2 years and have 24 CEUs to continue working in the state of Kentucky.

$90.00 Reactivation Fee 

$180.00 Reinstatement Fee 
 
Therapists from other states must use the same $150.00 Mandatory License Application. They will be required to send proof of NBRC credentials and all current license status from other states, to be licensed in the state of Kentucky.

Requirements for reinstatement of licensure after termination has occured.
  • Application for Reinstatement.
  • 24 current CEUs that meet the standard set forth by the KBRC.
  • Payment of reinstatement fee, $180.00.
  • KHEAA form answered and submitted with application.

Requirements to Present Your Reinstatement Request to the KY Board of Respiratory Care after revocation:
  • Application for Reinstatement.
  • How it happened + The Recovery Process + Future Goals and Plans = a written “what it was like, what happened, and what it’s like now.”
  • 4-5 letters of support – some personal e.g. from 12-Step program and/or church; some professional
  • Any treatment related documents – a letter of advocacy from the treatment provider or from a counselor involved in any on-going sessions
  • Copy of any monitoring contract/agreement e.g. KYPRN
  • Any court documents and/or arrest records if that pertains to the matter
  • Any “resolution” documents from Board action or legal action
  • Put the (9) sets of documents (or however many are asked) into a "nice" presentation binder or folder. Also (1) set un-bound for director, for total of 10 sets. Realize that the Board will be reading these – a positive impression is desired.

Contact the KBRC if you have any questions about the licensing process.

Click here to Pay By Credit Card
Note: Paying by credit card still requires that you fill out and send in the proper application found at the bottom of this page.

This application will allow users to pay their Reinstatement Fees, Application Fees and Enforcement Fees.
This online service accepts all major credit cards and contains a Portal Administration Fee of 3.5% of the amount due.
 
Below are the forms to send in by mail if paying by check or money order.

Note: 4/27/2016 All forms now have the new South Creek address.

Kentucky Board of Respiratory Care
2365 Harrodsburg Rd., Suite B350
Lexington, KY 40504-3335

Forms

If you have married, moved or had an address change during a two year license period, please use this form.
Change of Name / Address Form

 

 

 
Students Who Intend to Work
 
All students who intend to work as a student therapist; must have a student licensure with the KBRC and need to fill out the limited mandatory application. Fees for all licensures changed on August 18, 2016.
 
Temporary Licensure
 
Temporary licensure is a 6 month time limit based on the student's graduation date. Once a student graduates he or she must immediately upgrade to temporary status to be able to continue to work and practice respiratory. (The mandatory application is used for the temporary process.)
The temporary licensure is valid only till the licensee passes NBRC test.