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