NDBON Seal Logo

Application for Licensure by Endorsement

-Licensure Type

I am applying for licensure as a:

-Biographical Information

example: 10/10/1990 Make sure to include the dashes
If you do not have a U.S. Social Security Number do not
continue with this application: Call (701) 328-9780
.
In compliance with the Federal Privacy Act of 1974, the disclosure of the individual's
social security number on this form is mandatory pursuant to North Dakota Century
Code 43-50-02. The individual's social security number is used for identification purposes.

-Contact Information

Use numbers or letters only, no punctuation (periods, commas, etc.) or other special characters.

If outside of the United States include city, province, country, etc. here
Choose Out of State if you reside outside of North Dakota. For countries outside of the United States, choose Out of Country.
MAKE SURE YOUR STATE IS CORRECT. (When using your mouse scrolling wheel you may have inadvertently changed it while trying to scroll down the page.)
example: 123-456-7890
example: mail@domain.com
example: mail@domain.com

-Military and Military Spouse Status

Are you a member of the armed forces of the United States or a reserve component of the armed forces of the United States currently stationed?

In accordance to 43-51-01 “Military spouse” means a foreign practitioner who is the spouse of a member of the armed forces of the United States or a reserve component of the armed forces of the United States stationed in this state in accordance with military orders or stationed in this state before a temporary assignment to duties outside of this state.

According to this definition, are you a military spouse?