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.

Applications

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.

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 (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 applly for a Mandatory License.
Application for Mandatory and Temporary Certification.pdfApplication for Mandatory and Temporary Certification.pdf
 
$150.00 Mandatory License  is the license that is required to practice in Kentucky. The application must be accompanied by proof of an NBRC credential
 (CRT or RRT) and the $150 fee.  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.
Therapists  who are licensed in another state and are seeking reciprocity must use the Mandatory Certification application. THe application must be accompanied by proof of a current NBRC credential and verification of license that has ever been held in other states.
Application for Mandatory and Temporary Certification.pdfApplication for Mandatory and Temporary Certification.pdf
$135.00 Reactivation Application:  (This is not a renewal application.)
  Application for Reactivation 1.pdfApplication for Reactivation .pdf

$200 Renistatement Application:  This application is for practitioners who have held a license that has been expired less than 5 years. The application must be accompanied by proof of 24 approved CEU's that have been completed in the previous 24 months and payment of the $200 Fee. 
*Complete the Mandatory Certification application if your license has been expired more than 5 years.*


Application for  Reinstatement .pdfApplication for Reinstatement .pdf

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If you have married, moved or had an address change during a two year license period, please use this form.

  •  Change of name and address form.pdf

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Click here to make a credit card payment: Payment Portal
The credit card payment link will allow users to pay their Application Fees, Reinstatement Fees, Reactivation Fees, State Verification 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 is the address to send if sending by mail.
Kentucky Board of Respiratory Care

2365 Harrodsburg Rd., Suite B350
Lexington, KY 40504-3335


Please make checks and money orders payable to the KY State Treasurer.

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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.

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Please complete the form below for Open Records requests

KBRC Open Records Application 2020.pdfKBRC Open Records Application 2020.pdf

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. 
 
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 apply for a Temporary license in order to continue to work and practice respiratory.The Temporary license expires once the individual obtains the CRT credential from the NBRC. (The mandatory application is used for the temporary process.)