Board of Behavioral Health Examiners Payment Site

Endorsement Application

IMPORTANT: Use this screen only if applying for Licensure by Endorsement

STEP ONE:

Key in all required information below and make the appropriate payment via credit/debit card.

STEP TWO:

Complete the License by Endorsement application (including attaching all required documents) and submit online. The link to the License by Endorsement application will be sent to the email you select, or can be accessed by hitting “Continue” after your payment has been authorized.

STEP THREE:

Mail in any required documentation (if applicable).

Your application cannot be processed until ALL steps are completed.

Personal Information

First Name *

MI

Last Name

Home Address *

City *

State *

Zip *

Preferred Phone *

Email *

I acknowledge that pursuant to A.A.C. R4-6-215(C), application fees in subsections (A)(1) and (2) are non-refundable and other fees established in subsection (A) are not refundable unless the provisions of A.R.S. § 41-1077 apply. *

I Agree

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Endorsement Application

STEP ONE:

STEP TWO:

STEP THREE:

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