Applications and Forms

​​​​​​​​KBRC Payment Portal​​

The credit card payment link will allow users to pay their Application Fees, Reinstatement Fees, Reactivation Fees, State Verification Fees, Continuing Education approval fees and Enforcement Fees. This online service accepts all major credit cards and contains a Portal Serve​ Fee of 3.5% of the amount due.
MAKE A PAYMENT

​​​​​​​​​​Applications

​​​​​​​​Documents below are fillable Adobe PDFs. Please download to your device ​and open with Adobe​ Reader.​

Applications may be submitted by mail, fax or email. Please send emails to Tamara McDaniel at tamara.mcdaniel@ky.gov or, Rick Rose at rickl.rose@ky.gov. All applications submitted by email must be in PDF form. Photographs attached to the email are not accepted. All supporting documents such as proof of NBRC credentials and proof of license in other states must be in PDF form as well.​​​​

Mandatory Certification

Mandatory Certification is the license that is required to practice as a CRT or RRT in Kentucky. The application must be accompanied by proof of an NBRC credential (CRT or RRT). Therapists who are licensed in another state will use the Mandatory Certification application to seek reciprocity. The application must be accompanied by proof of a current NBRC credential and verification of license that has everbeen held in other states. The fee is $150.00.

*Complete this application if you held a previous license in Kentucky, that has been expired more than 5 years and is designated as Terminated.*

The license will be due for renewal ​every 2 years by January 30th and the licensee must have 24 approved CEUs in order to renew the license.

Download the application for Mandatory and Temporary Certification

Checklist for Mandatory Certificate applicants:​

  1. Download and complete s​igned application. Computer generated signatures are not accepted.
  2. Proof of an NBRC credential. May use NBRC verification, most recent certificate or card. New graduates may submit the NBRC score report.
  3. People seeking licensure who hold a current license in another state must provide a copy of that license. To expedite the licensing process we require that you provide a copy of a license that you now hold or have ever held in any state. We will accept license verification printouts from the state's website.
  4. Pay the $150 fee on the KBRC payment portal link found below or on the KBRC homepage.​
  5. Email, mail or fax the application. Emailed documents must be in PDF format. Please do not send photographs of any application or supporting documents.

Limited Mandatory (Student License)

Limited Mandatory (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 a Limited Mandatory license will expire upon graduation. To continue working, individuals must apply immediately for a Temporary License with the KBRC. The fee for a Limited Mandatory License is $60.00

Download Application for Limited Mandatory Certification


​Reactivation Application

This application is used to go from Inactive status to Active status.  This is not a renewal application.

The fee is $135.

Download Application for Reactivation


Reinstatement Application

This application is for practitioners who have held a license that is designated as Expired and have been expired less than 5 years. The application must be accompanied ​by proof of 24 approved CEUs that have been completed in the previous 24 months. The fee is $200.00

Complete the Mandatory Certification application if your license has been expired more than 5 years and is designated as Terminated.​

Download Application for Reinsta​tement


Temporary License (Graduate License)

Temporary License (Graduate 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 apply for a Mandatory License. The fee for a Temporary license is $102.00

Download Application for Mandatory and Te​mporary Certification


Forms

Change of Name and Address Form

Please use this form if you have had a name change or an address change.

Change of Name / Address Form



​​Open Records Request

Requests to inspect public records may be submitted online.​​

SUBMIT OPEN RECORDS REQUEST


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Continuing Education Approval Form

Please complete this form to submit courses for Continuing Education approval.

Continuing Education App​roval Form