Social Care License Renewal Form
Renew your social care license by providing updated professional, employment, and training details. Please complete all required fields to process your renewal.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
License Reference (Last 4 digits only)
*
Current Employer/Organization
*
Job Title/Role
*
Describe your professional practice over the past year
*
Continuing Education/Training Completed (list courses, workshops, or seminars attended in the past year)
*
Upload supporting documents (training certificates, proof of employment, etc.)
Upload a File
Drag and drop files here
Choose a file
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of
Renewal Declaration: I confirm that the information provided is accurate and complete to the best of my knowledge.
*
I agree
Submit Renewal
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