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Disclosure of this information is VOLUNTARY. However, failure to comply may result in this form not being processed. |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| The following materials are required to make Application for Licensure and/ or Examination in Illinois:\u003Cbr>1. Four page APPLICATION FOR LICENSURE and /or EXAMINATION.\u003Cbr>2. INSTRUCTION SHEET, which gives step by step application instructions for your profession.\u003Cbr>3. REFERENCE SHEET, which gives detailed coding information foryour profession.\u003Cbr>4. SUPPORTING DOCUMENTS, forms, and/or anyother documentation you may be required to submit with your application.\u003Cbr>5. If the name shown on your supporting documents is different from that shown on your application, you must submit PROOF OF LEGAL NAME change-copy of marriage license, divorce decree, affidavit or court order. |  |  |  |  | Carefully follow all steps outlined on the INSTRUCTION SHEET. In addition, note the following:\u003Cbr>A. Type or print legibly with black ink only.\u003Cbr>B. FEES ARE NOT REFUNDABLE.\u003Cbr>C. Disclosure of your U.S. social security number, if you have one, is mandatory, in accordance with 5 Illinois Compiled Statutes 100/10-65 to obtain a license. The social security number may be provided to the Illinois Department of Public Aid to identify persons who are more than 30 days delinquent in complying with a child support order, ortothe Illinois Department of Revenue to identify persons who have failed to file a tax return, pay tax, penalty or interest shown in a filed return, or to pay any final assessment or tax penalty or interest, as required by any taxAct administered by the Illinois Department of Revenue, or to other entities for verification of identification. |  |  |  |  |  |  |  |\n| PART I: Application Category Information |  |  |  |  |  |  |  |  |  |  |  |  |\n| A. Check the box indicating the appropriate information regarding your application. Military Military Spouse Not Military Decline to Answer Military service member is defined as.“Service member means any person who, at the time of application under this Section, is an active duty member of the United States Armed Forces or any reserve component of the United States Armed Forces, the Coast Guard, or the National Guard of any state, commonwealth, or territory of the United States or the District of Columbia or whose active duty service concluded within the preceding 2 years before application.”The following will be considered proof of you or your spouse’s active military status: DD214, Letter of Service signed by Unit Commanding Officer, or Proof of Service document from the Servicemember's electronic personnel portal. Proof for Spouses: Military Permanent Change of Station Orders with the spouse identified by name; Official Notification of Change of Assignment with your marriage license, a certified DD1172 verifying marital status, or a letter signed by the commanding officer verifying change of assignment and the name of the military spouse.\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  |  |\n| B. SEE REFERENCE SHEET, CHART I, OR INSTRUCTIONS PRIOR TO COMPLETING ITEMS 1 THROUGH 4 |  |  |  |  |  |  |  |  |  |  |  |  |\n| 1. PROFESSION NAME |  | 2. PROFESSION CODE |  |  |  | 3. LICENSURE METHOD |  |  |  |  |  | 4. FEE\u003Cbr>$ |\n| C. CHECK BOX INDICATING THE APPROPRIATE INFORMATION REGARDING YOUR APPLICATION |  |  |  |  |  |  |  |  |  |  |  |  |\n| | This is the first time I have made application for this profession in Illinois.\u003Cbr>I have previously made application for this profession in Illinois. However, my previous application expired and Iam now reapplying.\u003Cbr>Other:   |  |  |  | My application for this profession had previously been denied in Illinois. I am reapplying since I have fulfilled additional requirem","cbCaibb3OYzlsqEl","https://ap.wps.com/l/cbCaibb3OYzlsqEl","pdf",289095,"English","# PART I: Application Category Information\n## A. Application category selection\n## B. Reference sheet, chart, or instructions for items 1 through 4\n# PART II: Applicant Identifying Information\n# PART III: Education Information","[{\"question\":\"What materials are required to submit an Illinois licensure and/or examination application?\",\"answer\":\"The form lists a four-page application plus an instruction sheet, a reference sheet, supporting documents, and any additional documentation required for the profession.\"},{\"question\":\"What are the key instructions for completing the form?\",\"answer\":\"It instructs applicants to type or print legibly with black ink only and to carefully follow all steps in the instruction sheet. It also states fees are not refundable.\"},{\"question\":\"What information must applicants provide for identity and contact details?\",\"answer\":\"Applicants must provide name, title, U.S. social security number, mailing and business addresses, maiden name or other submitted names, mother’s maiden name, place and date of birth, age/sex, telephone numbers, and the required email address.\"}]","APPLICATION FOR LICENSURE AND/OR EXAMINATION - Application Category Information | PDF",1789993060]