Physical Therapy Jurisprudence Exam Registration Form

Physical Therapy Jurisprudence Exam Registration Form
Register to sit for the Physical Therapy Jurisprudence Exam. Please complete all required fields to secure your exam registration.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Highest Degree Earned
State of Licensure (if applicable)
Preferred Exam Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you registering as a first-time candidate or a re-exam candidate?
Name of Physical Therapy Program Attended
Upload Proof of Degree or Eligibility (PDF, JPG, or PNG)
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