Application: PT Licensed in Another State

Please thoroughly review the document above titled "PT Instructions and Application Forms - Another State" before submitting your application. Any processing fees incurred are your responsibility. Please note: most forms required for your application are contained in the above titled document "PT Instructions and Application Forms - Another State".

Click "Online Application" above to get started on submission of the online application.

Please note: Before beginning the online application process you will need to have detailed information available, including: social security number or alien card number or Tax ID number; if applicable, other licenses or registration numbers, date issued, and expiration dates; record of clinic affiliations (including: facility name, address, phone number, time frame you were there (mm/yyyy to mm/yyyy) and two references, preferably 2 PTs, for each location with address and phone number)

DOCUMENTS TO BE MAILED DIRECTLY TO THE BOARD OFFICE

These forms may be mailed to the Board office prior to submission of your licensure application and fees. They will be placed in a pending file until your application file is opened. After your file is opened – you will receive an email in regards to your online application/account. You may view your application checklist online. If an item is marked “completed” no further action is required

• FORM-RECOMMENDATION: Two recommendation forms (total) submitted by two physical therapists registered or licensed to practice physical therapy in the United States or Canada. (Choose two physical therapist references from those listed on the practice location section of your application to complete the recommendation forms. They must be mailed in a sealed envelope directly to the Board office by the individual filling out the form)
• FORM-AFFIDAVIT OF APPLICANT: A recent full faced 2x3 photograph (printed on photo paper) of the applicant affixed to the Affidavit of Applicant form, completed and notarized. (Please note: this form requires 2 notary stamps).
• DOCUMENT-TRANSCRIPT: Evidence satisfactory to the board that the applicant has met the educational requirements of Minnesota Statutes section 148.721 or 148.722 as demonstrated by a certified copy of a transcript. (The official transcript with the DEGREE GRANTED DATE must be sent directly to the MN Board of PT office from the school via secure email or in a sealed envelope)
• VERIFICATION OF LICENSE: Please have your license verification sent directly to the Board Office from each state/country you are or have been licensed.
• FORM-CERTIFICATION OF EDUCATION: Must be completed and mailed from the University/College directly to the Minnesota Board of Physical Therapy Board Office. This form is to be mailed from your school not more than 13 weeks prior to graduation.
• FORM-EMPLOYMENT VERIFICATION: A record of the applicant’s current and previous physical therapy practice experience. (Employment verifications forms from each of your employers during the past 5 years).
• FORM-MALPRACTICE HISTORY: A person who has previously practiced in another state shall submit the following additional information with the license application for the five-year period of active practice preceding the date of filing application in this state

QUESTIONS

If you have specific questions about the application process, please call 612-627-5406, fax 651-797-1377, or e-mail: Physical.Therapy@state.mn.us

Address all written correspondence to: MN Board of Physical Therapy 335 Randolph Avenue, Suite 285, St. Paul, MN 55102

• It is the applicant’s responsibility to provide written notification to the Board within 30 days of an address change.
• All physical therapists practicing in Minnesota have a legal responsibility to comply with the Minnesota Physical Therapy Practice Act: Minnesota Statutes 148.65-148.78 Minnesota Rules 5601.0100-5601.3200 The Minnesota Physical Therapy Practice Act may be viewed at: www.revisor.leg.state.mn.us/statutes/?id=148 and www.revisor.leg.state.mn.us/rules/?id=5601 or on the Board website at http://mn.gov/boards/physical-therapy/statutesandrules/

If any part of this Fact Sheet conflicts with the Minnesota rules or laws, the rules or laws take precedence. It is your responsibility to understand and comply with the regulations. Please call if you have any questions

It is your responsibility to make sure your file is complete; i.e. completed application, exam scores, and documentation have been received by the Board. The Board will not review applicants with incomplete files. Applicants who answer yes to a question on their application or provide incomplete information are reviewed by the licensure committee at a PT Board meeting*. Wall and wallet certificates will be issued after the Board meetings. Passing score on fixed testing date:

*On rare occasions, a Board meeting date may change. **Official transcript showing degree was granted must be received prior to PT Board Meeting or Review Date. ALL PHYSICAL THERAPY LICENSES EXPIRE ON DECEMBER 31 OF EACH YEAR It is your responsibility to make sure your file is complete; i.e. verifications, completed application, exam scores, and documentation have been received by the Board. The Board will not review applicants with incomplete files. As a general rule, the application and documentation must be received two weeks prior to the meeting or review date. Please note: Applicants who answer yes to a question on their application or provide incomplete information are reviewed by the licensure committee at a PT Board meeting*. Wall and wallet certificates will be issued after the Board meetings.

1. a certified marriage certificate specifying the name change following marriage;*
2. a certified divorce or dissolution of marriage decree specifying the name change, or;*
3. other certified court order specifying the name change.

Please do not submit foreign marriage certificates that do not reflect your name change following marriage, as the Board is unable to accept them for purposes of changing your name on your license. *You may submit a notarized copy

How to obtain a notarized document:

1. Make a photocopy of the document (marriage certificate, etc).
2. Take the photocopy along with the original document to a Notary.
3. The Notary will look at the original document and the photocopy.
4. The Notary will sign/stamp/seal the photocopy and write a statement to the effect that they have viewed the original and this is an exact copy. Some Notaries will attach a paper (with a similar statement, signature/stamp/seal) to the copy.