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Rev. 10/08/2014TRAINEESHIP APPLICATIONSTATEMENT OF AUTHORIZATIONPHYSICAL THERAPIST SEEKING LICENSURE/LICENSURE WHO NEED A 160HOUR TRAINEESHIPAuthorization to work as a trainee is valid only for the
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How to fill out physical formrapist seeking licensurerelicensure

01
Obtain the physical form necessary for therapist seeking licensure/relicensure.
02
Fill out the personal information section of the form, including your full name, contact information, and any identifying numbers, such as a license number.
03
Provide your educational background, including the names of institutions attended and degrees obtained.
04
Document your work experience as a therapist, including previous positions held and dates of employment.
05
Include any additional certifications or licenses you currently hold.
06
If applicable, disclose any disciplinary actions taken against you or any legal issues you have been involved in.
07
Review the completed form for accuracy and make any necessary corrections or additions.
08
Sign and date the form to certify that the information provided is true and accurate.
09
Submit the filled-out physical form to the appropriate licensing board or regulatory agency.

Who needs physical formrapist seeking licensurerelicensure?

01
Any therapist who is seeking initial licensure or undergoing relicensure process.

What is PHYSICAL THERAPIST SEEKING LICENSURE/RELICENSURE Form?

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The physical form for a therapist seeking licensure/relicensure is a document that may include a physical health assessment, medical history, and other related information.
Therapists who are seeking licensure or relicensure are required to file the physical form.
The physical form for a therapist seeking licensure/relicensure can usually be filled out by providing personal and medical information as requested on the form.
The purpose of the physical form for a therapist seeking licensure/relicensure is to ensure that the therapist is physically able to perform the duties of their profession.
The information that must be reported on the physical form for a therapist seeking licensure/relicensure may include medical history, current health status, and any relevant medical conditions.
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