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The North Carolina Respiratory Care Board

Application for Licensure

Applicant Information

All of the information with * next to them are required.
Last Name:
First Name:
Middle Initial:
Maiden Name:
Social Security
Date of Birth
Gender
Race
Email:
Home/Cell Phone:
Work Phone:
Fax:
*
*
*
*
*
*
*
*

Mailing Address

Address Type:
Address 1:
Address 2:
City:
State:
Zip:
*
*
"Physical Address if Address1 is a PO Box."
*
*
*

If you know your future practice site please enter the infirmation below.

Primary Practice Address

Firm:
Practice Type:
Address 1:
Address 2:
City:
State:
Zip:
"Physical Address if Address1 is a PO Box."

EDUCATION

Request an official transcript from the respiratory care program you completed. The program must be approved by the Commission on Accreditation for Respiratory Care. A transcript is considered official when it is issued by the institution where the training program was completed, affixed with its seal and provided in a sealed envelope.

Education Information (Enter Respiratory Care Education First)

Institue Name:
City:
State:
Zip:
Program Type:
Date Completed:
*
*
*
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To enter additional degrees earned click the Add education button

EXAMINATION

Applicants for Licensure must request a credential verification letter from the National Board for Respiratory Care (NBRC) to be sent to the NCRCB. Here Click to request the letter.

LICENSED IN ANOTHER JURISDICTION:

If you currently hold or have held a health care provider license in any jurisdiction(s), have the licensing agency complete and send an official verification of license status to the NCRCB.

FEES:

Active License- $50.00 Application fee plus $125.00 License fee plus $38.00 for your finger prints and background (Total $213.00) will be charged to your card.

After the application has been submitted you will be sent a notice of all missing documents and a background check packet. The fingerprint card and forms must be returned to the Board office. NO LICENSE will be issued until the NC SBI completes the process and returns a report to the Board office. This process usually takes 2 weeks.