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    Maryland Department of Health
    Board of Occupational Therapy Practice

    ​​​​​​​​Downloaded Forms

     
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    Forms

    All documents may be submitted to the Board office via:

    1) Email:  mdotboard.user@maryland.gov    or

    2) Fax:  (410) 402-8561   or

    3) US Mail:  MD Board of Occupational Therapy, Spring Grove Hospital Center, 55 Wade Avenue, Tuerk Building, 2nd Floor, Baltimore, MD  21228.  

    Necessary forms for an initial license:

    • Completed application​ and an application fee of $200.  Your payment must be mailed to the office; a scanned copy of your payment is not acceptable.

    • Completed State and FBI Criminal History Records Check (begin​ning February 1, 2018)   A copy of the Agency Privacy Requirements For Noncriminal Justice Applicants can be viewed here​ and here. ​ Please print out copies of both pages, sign them, and upload them with your documents.​ Fingerprint results are only valid for 30 days after being fingerprinted. Your application must be submitted within those 30 days.

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

    • Verification of initial certification or examination from NBCOT*

    • Continuing Competency Requirement Compliance Report Form (If you are currently NBCOT certified, the Continuing Competency Requirement is waived.  Continuing competency requirement documentation is required if your NBCOT certification is not current, you graduated more than one year ago, or if you have been out of practice for 3 or more years.)

    *For a temporary license, a confirmation of examination registration and eligibility to examine notice from NBCOT will be needed in lieu of NBCOT certification verification.

    ALL APPLICANTS SHOULD ALSO DOWNLOAD THE APPLICANT'S CHECKLIST AND BOARD SURVEY​​.     

     Reinstatement Forms

    To be compliant with the biennial schedule implemented in 2016, expiration dates for reinstated licenses will be determined by the original year of licensure.  Licensees with an original even licensure year will have a reinstatement expiration date ending in an even year.  Licensees with an original odd licensure year will have a reinstatement date ending in an odd year.  Fees will be determined by the original licensure date.

    Necessary forms for reinstatement:

    • Completed reinstatement application​, along with a fee between $225 and $450.  Contact the Board office for exact fee.  Your payment must be mailed to the office; a scanned copy of your payment is not acceptable.​

    • Documentation certifying a minimum of 24 contact hours of continuing education activities obtained with a 2-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(3) for more information.  This requirement is waived if you are currently NBCOT certified.

    • Completed State and FBI Criminal History Records Check​​ (beginning February 1, 2018)​    A copy of the Agency Privacy Requirements For Noncriminal Justice Applicants can be viewed here​ and here.  Please print out copies of both pages, sign them, and upload them with your documents.​ Fingerprint results are only valid for 30 days after being fingerprinted. Your application must be submitted within those 30 days.
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    • 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.

    Renewal Forms

    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.  

    Renewal is available from May 1 through May 31.  The grace period extends to June 30.  A $25 late fee is added from June 16 to June 30.

    • 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.  

    • If you have not been fingerprinted for the Maryland Board of Occupational Therapy Practice, a completed State and FBI Criminal History Records Check is needed.   A copy of the Agency Privacy Requirements For Noncriminal Justice Applicants can be viewed here​ and here.  Please print out copies of both pages, sign them, and upload them with your documents.​ ​Fingerprint results are only valid for 60 days after being fingerprinted. Your application must be submitted within those 60 days.​

    • 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).  The late fee will not be assessed during the state of emergency.

    • Incomplete applications will not be accepted as complete.

    • A paper renewal application can be found in PDF format ​

    • REMINDER: If your license is up for renewal, and you have not been fingerprinted for the Maryland Board of OT, your license will not be renewed, and you will need to reinstate after the deadline. Renewal fees are NON-REFUNDABLE.​  You do not need to be fingerprinted if it was done for the Board during the last renewal period and you did not have a lapse in licensure

      Verification (Letters of Good Standing) Requests ​

      A written verification of a licensee's status, with the Board seal affixed, may be provided upon request.  A request for written verification must be in writing to the Board, and include:

      • Name of the licensee to be verified
      • Address where the completed verification is to be forwarded; and
      • A money order, check or credit card order in the amount of the verification of licensure fee established by the Board in COMAR 10.46.05.01.  The fee is $20 per licensee.

      Download and mail in the verification request form.  Click here for a downloaded paper form.  ​

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       ​CCR or Licensing Listing Requests

      ​If you are seeking approval of a continuing competency requirement activity, download a paper copy of the contact hour approval request form by clicking here​.  ​


      If you are requesting a license listing, please click here​.


      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.



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