Please enter your information and click "Submit" when you're done. All fields in blue are required.

Please record your account credentials for future reference after clicking the submit button.

Please make sure to complete all fields accurately. In particular, if you are licensed or applying for a license under certain PA Boards, you will need to enter additional information to ensure your record is sent to the PA Department of State, including your PA Board license number if applicable. Enter your full name exactly as it appears on your license, be sure to include your correct Date of Birth and SSN as well.

If you have any questions, please contact us at