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Board of Occupational Therapy Practice

Forms

Listed below are various forms utilized by the State Board of Occupational Therapy Practice for original licensing and renewal and/or reinstatement of an existing license.  Please return these forms in the mail since originals are needed.  Faxes and email versions are not accepted at this time.

To further its commitment to equal opportunity, the Maryland Board of Occupational Therapy requests applicants to provide, voluntarily, their race/ethnicity information.  This information will be used for statistical purposes only by authorized personnel.

Explanation of Race/Ethnic Categories:

  1. American Indian or Alaska Native - a person having origins in any of the original peoples of North or South America, including Central America, and who maintains tribal affiliations or community attachment.
  2. Asian - a person having origin in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
  3. Black or African American - a person having origins in any of the black racial groups of Africa.
  4. Hispanic or Latino - a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
  5. Native Hawaiian or other Pacific Islander - a person having origins in the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
  6. White - a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

 


 

The following forms are needed to apply for an official license:

  • Completed application, along with 2 self-addressed labels and an application fee of $200

  • 2 moral character endorsement forms

  • Successful completion of the Maryland Board of Occupational Therapy jurisprudence exam

  • Letters of verification from any state or country in which you've been licensed

  • Verification of initial certification or examination from NBCOT

These forms are needed to apply for temporary licensure.  It is also advisable to print/view the Frequently Asked Questions for Temporary Licensure.

  • Completed application, along with 2 self-addressed labels and an application fee of $200

  • 2 moral character endorsement forms

  • Successful completion of the Maryland Board of Occupational Therapy jurisprudence exam

  • If currently and/or previously authorized to practice in any other state or country, a letter of verification of licensure, registration, or certification in good standing from the appropriate authority of that state or country.

  • Confirmation of registration and eligibility letter from Professional Examination Service (PES)

ALL APPLICANTS SHOULD ALSO DOWNLOAD THE APPLICATION INSTRUCTIONS, APPLICANT'S CHECKLIST, LICENSURE PROCEDURE PAMPHLET AND BOARD SURVEY.

The Code of Maryland Regulations, Title 10, Department of Health and Mental Hygiene, can be viewed at www.dsd.state.md.us.  Click COMAR Online from the selection bar.  Select #3 under the search options.  Select Title 10.  Page down to select Subtitle 46, Board of Occupational Therapy Practice, and then select the chapter you wish to view.  The pdf version of the statute and regulations can be viewed by visiting our Practice Act & COMAR Regulations page.  


Licensure Forms

 

Application:

(2012_10.46.01.02_application.pdf) 


Moral Character Endorsement Form:   
(2 forms required)   

(2012_moral_character001.pdf)




Verification of Licensure Form:    

(2012_10.46.01.02_verification.pdf)








Licensure Process Pamphlet:   

(2011_10.46.01.02_licensure_pamphlet.pdf)


Applicant's Checklist:   

(2011_10.46.01.02_app_checklist_new.pdf)

 

Board Survey:   

(sample_2007_10.46.01.02_Survey.pdf)


NBCOT Verification of Certification Form:   

(sample_nbcot_verification_certification.pdf)

Sample NBCOT Confirmation of Examination     Registration and Eligibility to Examine:    

(sample_nbcot_eligibility_letter)

Temporary Licensure - Frequently Asked     Questions:    

(2011_10.46.01.02_TempQA)

COMAR Regulations Link:    

View the COMAR Table of Contents


Continuing Competency Requirements:   

(sample_2011_CCRRegs-2012.pdf)

Continuing Competency Requirement Compliance Report Form: 

(2012_10.46.04.06_Continuing_Competency_Requirement_Compliance_Report.pdf)


 


 Reinstatement Forms

 The following forms are needed to apply for a reinstatement:

  • Completed reinstatement application, along with a fee of $225

  • Documentation certifying a minimum of 12 contact hours of continuing education activities obtained with a 1-year period preceding the application for reinstatement as specified in COMAR 10.46.04.  If there has been a lapse of 3 or more years in practice, please see COMAR 10.46.04.04 C(2)(a)(b) for more information.

  • 2 moral character endorsement forms

  • Verification of initial certification or examination from NBCOT

  • If currently and/or previously authorized to practice in any other state or country, or both, a letter of verification of licensure, registration, or certification in good standing from the appropriate authority of that state or country.

  • Successful completion of the Maryland Board of Occupational Therapy Jurisprudence Exam. 

Licenses expire on June 30th.  Notice of renewal and application shall be sent to the last known address of each active licensee at least 30 days before the expiration date of the license.  The following is needed:

  • A completed renewal application shall be returned to the Board, postmarked, by the deadline for renewal.  At the time of licensure renewal, a licensee who has completed the continuing education requirement shall sign the
    renewal form attesting to the completion of the required contact hours as specified in COMAR 10.46.04.05.>

  • Licensees who are audited, must successfully complete the requirement of the audit prior to renewal of licensure as specified in COMAR 10.46.04.05.

  • Renewal fees are published on the renewal page.  

  • A completed renewal application postmarked after the deadline shall be assessed a late fee as specified in COMAR 10.46.05 (currently $25).

  • Incomplete applications will not be accepted as complete.


  •  

    Renewal/Reinstatement Forms

Renewal Application:   

2014_10460102_renewal_app_for_web.pdf


Renewal  Instructions:

Instructions will be available by the end of April, 2014. Contact the Board office if you need your registration code.

Reinstatement/Reactivation Instructions:

(2007_10.46.01.02_reinstate_reactivate_instructions.pdf)

Reinstatement/Reactivation Application:

(2012_10.46.01.02_application.pdf)

Continuing Competency Requirement Compliance Report Form: 

(2012_10.46.04.06_Continuing_Competency_Requirement_Compliance_Report.pdf)

Moral Character Endorsement Form:   
(2 forms required)   

(2012_moral_character001.pdf)


NBCOT Verification of Certification Form: 

(sample_nbcot_verification_certification.pdf)

Verification of Licensure Form: 

(2012_10.46.01.02_verification.pdf)


COMAR Regulations Link: 

View the COMAR Table of Contents

Continuing Competency Requirements: 

(sample_2011_CCRRegs-2012.pdf)