Certification Request () (Korean) (Spanish) (Vietnamese) (Simplified Chinese)

This form is to be completed and submitted when a California Licensee is requesting a copy of their license information be sent to another state. Applications for Certification Letter can also be submitted online at www.breeze.ca.gov. If you are requesting your license information to be sent to more than one state, you will need a separate application and fee for each request. The information on the letter includes your name, license type, license number, date if issuance, date of expiration, and if you were licensed by reciprocity. Information regarding when NIC exam were administered in California is also included. Letters are sent directly to the state requested and will not be sent to the licensee.

Change of Address () (Korean) (Spanish) (Vietnamese) (Simplified Chinese)

Change of Name

The California Department of Consumer Affairs may recognize a name change by an applicant or licensee if that name is now his or her legal name for all purposes and if the change is not made for fraudulent purposes and is not misleading to the public.

Disclosure Statement Regarding Criminal Pleas/Conviction (Korean) (Spanish) (Vietnamese) (Simplified Chinese)

Disclosure Statement Regarding Disciplinary Action (Korean) (Spanish) (Vietnamese) (Simplified Chinese)

Complete this form if you ever had any professional or vocational license or registration denied, suspended, revoked, placed on probation or other disciplinary action taken by this or any other governmental authority in this state or any other state, or any foreign country.

Duplicate/Replacement License Request () (Korean) (Spanish) (Vietnamese) (Simplified Chinese)

This form is to be completed and submitted when requesting a duplicate copy of your license. Duplicates are only to be issued when a license has been lost, stolen, or destroyed, per BCP Section 7398.