I hereby make application to practice as a physical therapist in North Dakota subject to the provisions of the law and the rules and regulations in the North Dakota Board of Physical Therapy by:
I hereby make application to practice as a physical therapist assistant in North Dakota subject to the provisions of the law and the rules and regulations in the North Dakota Board of Physical Therapy by:
In compliance with the Federal Privacy Act of 1974, applicants are advised that the disclosure of an individual's social security number on this form is mandatory under §43-50-02 of the North Dakota Century Code. The number is used for identification purposes and for testing and licensing through the Federation of State Boards of Physical Therapy. The penalty for not including the number is the inablility of the applicant to be tested and licensed as a physical therapist.
In compliance with the Federal Privacy Act of 1974, applicants are advised that the disclosure of an individual's social security number on this form is mandatory under §43-50-02 of the North Dakota Century Code. The number is used for identification purposes and for testing and licensing through the Federation of State Boards of Physical Therapy. The penalty for not including the number is the inablility of the applicant to be tested and licensed as a physical therapist assistant.
Provide your FSBPT ID Number. If you don't know your FSBPT (Federation of State Board of Physical Therapy) ID Number, you may look online at https://www.fsbpt.org/.
What is your current Employment Status?
