REQUEST FOR LICENSE CERTIFICATION
(ONLINE USE ONLY)

Please complete this form in its entirety. Incomplete forms will be rejected.

This application is a request to send your licensing and educational information to another state. This is NOT an application to renew your license in West Virginia. To renew your license online, go to www.wvbbc.com and click on "Individual License Renewal."

Requirement for Processing Include:
$35.00 processing fee
Completed Application

Instructions:
1. Enter your SSN and License Number.
2. Click on ‘Lookup’
3. Your information should fill in automatically. If your address or phone number has changed, please change it now.
4. Enter the State Board office’s information that needs your license certification. Make sure to enter their email address as this is how we send all certifications now.
5. Click on ‘Make Payment’ and pay with a debit/credit card.

Processing time for license certifications is typically 1-2 weeks.
Please do not reach out to our office regarding the status of your license certification request until after this timeframe.

YOUR INFORMATION
SSN:		License Number:

Name:

License Number:

Address:

City:

State:

Zip Code:

County:

Phone:

STATE BOARD THAT WILL RECEIVE YOUR INFORMATION

State Board Name:	*		Board Phone:	*
Board Address:	*
Board City:	*	State:	Zip Code:	*
Boards Email: