Application for Initial License as a Registered Intern

Pursuant to W. Va. Code §30-1-27, a person shall be granted an occupational or professional license, registration, or certificate if the person has been licensed or certified in another state, the license, registration, or certificate is in the same discipline and at the same practice level as the license, registration, or certificate for which the person is applying in this state and the person meets other conditions prescribed by W. Va. Code §30-1-27.

Personal Information


First Name:	Middle Initial:	Last Name:	Suffix:
Maiden Name:	Gender:	Date of Birth:	Social Security Number:
Place of Birth:		NABP e-Profile ID:
		If you do not know your NABP e-Profile ID, please go to the NABP site to look it up.
Upload a 3x4 inch head and shoulders photograph. Click here for recommendations on uploading files.