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45QHR200 (07/13/2023)ST A T E B O A R D O F C O SME T O L O GY Telephone: 8333672762 Fax: 7177055540 Email: stcosmetology@pa.gov Website:www.dos.pa.gov/cosmetMailing Address:Physical Address:State
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01
Obtain a verification of non-practice form from the appropriate licensing board or organization.
02
Fill out your personal information including full name, address, contact information, and license number if applicable.
03
Indicate the time period for which you are requesting the verification of non-practice.
04
Provide an explanation for why you are requesting the verification of non-practice.
05
Sign and date the form before submitting it to the licensing board or organization.

Who needs verification of non-practice?

01
Healthcare professionals who have taken a break from practicing and need to provide proof of their non-practice status to a licensing board or organization.
02
Healthcare professionals who are transitioning to a new job or state and need to verify that they have not been practicing during a specific time period.
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Verification of non-practice is a statement confirming that the individual has not practiced in a specific field during a certain period of time.
Individuals who have not practiced in a specific field for a certain period of time are required to file verification of non-practice.
Verification of non-practice can be filled out by providing personal information, details of the non-practice period, and any additional required information.
The purpose of verification of non-practice is to confirm that the individual has not practiced in a specific field during a certain period of time.
The information reported on verification of non-practice includes personal details, non-practice period details, and any additional required information.
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