Creating a Report: Check the sections you'd like to appear in the report, then use the "Create Report" button at the bottom of the page to generate your report. Once the report is generated you'll then have the option to download it as a pdf, print or email the report.
Application for Certification as a Rehabilitation Provider (rev. 5/2018)
General Information for Certification as a Rehabilitation Provider (rev. 7/2011)
Verification of Experience for Rehabilitation Provider Certification (rev. 5/2018)
Out-of-State License or Certification Verification (4/2018)
Licensure/Certification Verification of Out-of-State Supervisor (4/2018)
Rehabilitation Provider Application for Reinstatement of a Lapsed Certificate (5/2018)
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