Online Form 5 - Application for Limited Permit

Laws, Rules & Regulations Consumer Information Contact Information License Statistics Professional Practice Mandated Training Related to Child Abuse Continuing Education Frequently Asked Questions Education Requirements For Licensure Licensure & Practice License Requirements Application Forms Board Meetings Waiver Entities

All applicants for a limited permit must initially submit Form 5 along with the $70 limited permit fee. You must also submit a Form 5CS - Certification of Supervisor for Limited Permit and Operating certificate or certificate of incorporation along with your application.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

Changes to Supervisors and/or Settings
If you change supervisors and/or settings, or you have to add or remove a supervisor or setting, after a permit is issued, you must obtain an amended permit using the Limited Permit Change Form. After changes are processed you will receive an amended permit. A fee is not required for an amended permit issued as a result of a change in supervisor or setting. You must also submit a Form 5CS - Certification of Supervisor for Limited Permit for each new supervisor you are adding (see Upload Additional Documentation above).