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License Application

Qualification Application Packet  PDF
Qualification Application  WORD | PDF
Clinical Requirements Form  WORD | PDF​
Supplemental Application: Authorization to Practice through Military Training or Experience Equivalency WORD | PDF
Supplemental Application: Authorization to Practice for Military Spouse or Domestic Partner WORD |PDF​
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License Renewal

Peer Review Summary Form  WORD | PDF
MANA Declined Reporting Form  WORD | PDF​
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Auscultated Acceleration Test

Auscultated Acceleration Test Standard  PDF
Auscultated Acceleration Test Graph  PDF
Auscultated Acceleration Test Examples  PDF​
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Information Update

Update Your Licensing Record Online
Customer Information Update Form  WORD
Affidavit of Licensure  WORD
​Continuing Education Self-Study Verification Form  WORD | PDF​
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Consumer Forms

Complaint Form  WORD
Public Records Request Form  WORD​
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Traditional Midwife Information Disclosure

Traditional Midwife Information Disclosure Form  WORD | PDF
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