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Below is a list of multiple instructions, applications and forms.

All forms and applications shall be completed in its entirety to be accepted.

The board does not accept cash nor personal checks. All fees must be paid in the form of a money order, business check or cashiers check.

1. Endorsement Applicant Checklist and Application for Licensure
For Physical Therapists and Physical Therapist Assistants applying for licensure by endorsement from another state.
Download Fee: FREE
Download Now

1a. Foreign Applicant Checklist and Application for Licensure
For PT applicants not educated in the United States.
Download Fee: FREE
Download Now

2. PT / PTA Application
Application to become a licensed Physical Therapist or Physical Therapist Assistant in West Virginia. This application is for Exam, Endorsement, and WV delinquent/inactive licensee applicants.
Download Fee: FREE
Download Now

3. New Grad /Exam Applicant Checklist & Application for Licensure
For individuals applying for licensure by examination.
Download Fee: FREE
Download Now

3a. Exam Application and Instructions
You may apply for the examination only while you are applying for a WV license.
Download Fee: FREE
Download Now

3b. Exam Applicant- Special Accommodations Request Form
Please complete this form if you have any needs for special accommodations for the exam.
Download Fee: FREE
Download Now

4. CE Requirements for Reactivating Licensee
Please refer to these CE requirements for reactivation of a delinquent or inactive license.
Download Fee: FREE
Download Now

4a. Reactivation of a Delinquent License Application and Instructions
For licensees wishing to reactivate a delinquent license.
Download Fee: FREE
Download Now

4b. PT Reactivation of an Inactive License Application and Instructions
For Physical Therapists wishing to reactivate an inactive license.
Download Fee: FREE
Download Now

4c. PTA Reactivation of an Inactive License Application and Instructions
For Physical Therapist Assistants wishing to reactivate an inactive license.
Download Fee: FREE
Download Now

4d. PT Inactive Application
For Physical Therapists requesting inactive status.
Download Fee: FREE
Download Now

4e. PTA Inactive Application
For Physical Therapist Assistants requesting inactive status.
Download Fee: FREE
Download Now

5. Temporary Permit Application
A position as a PT/PTA in WV is required before requesting a temporary permit. You must also complete a PT/PTA licensure application and pay licensure and application fees before a temporary permit can be issued.
Download Fee: FREE
Download Now

6. Affidavit of Lost or Replacement Documents
Submit this form to request replacement documents from the board.
Download Fee: FREE
Download Now

7. Name / Address Change Notification Form
You are required to provide the board with current contact information.
Download Fee: FREE
Download Now

8. Emergency & Temporary Absence Form
You are required to complete this form for any emergency or temporary absences. This form must be turned in with your biennial renewal.
Download Fee: FREE
Download Now

9. Request for Waiver of Continuing Education
Submit this form if you need to request a waiver of continuing education.
Download Fee: FREE
Download Now

Certification of Copy
Use this form for a Notary to verify a copy as an original.
Download Fee: FREE
Download Now

Verification Request for Endorsement Applicants
Please complete this form and forward to any jurisdictions you are or have ever been licensed/registered (active or not) as a PT/PTA/AT.
Download Fee: FREE
Download Now

WV Verification Request Form
Complete and submit this form to our office if you need verification of your WV license/registration sent to another jurisdiction.
Download Fee: FREE
Download Now



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