Initial Application

License Type

Indicate which license you are applying for:

Certified Respiratory Therapist

Registered Respiratory Therapist

Registered Polysomnographic Technologist

If applying for both a CRT and RPSGT or a RRT and RPSGT license, please select both.

Personal Information


Are you an active member of, or a spouse of, a member of the armed forces of the United States or a reserve component of the armed forces of the United States?	Yes	No
Please provide proof of military orders or military spouse status. Click here for recommendations on uploading files.

Home Address


Street Address:
City:	County:	State:	Zip:
	Select Other if your county is not in North Dakota.
Phone:	Email:

Employer Address


Employer (If known at this time):			Phone:
Street Address:
City:	County:	State:	Zip:
	Select Other if your county is not in North Dakota.