LLPVRC Board of Examiners
PO Box 41594, Baton Rouge, LA 70835
225.922.1435 phone / 225.922.1352 fax /

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Below are the forms needed to complete the application process. Please print and complete them. 

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Application Packet

Download & Print Packet (21 pages)
Packet includes the following:

Letter of Instructions


Related Degree, R.S. 3447A5




Reference Letter Form (two)


Verification of Rehab Work Experience


Letter of Intent


Application Checklist


Requirements for Licensure and Renewal


Supervisory Work Experience Plan


CRC Examination Content


Retirement Status

Requesting Retirement Status:

In order to qualify for Retirement Status, you must submit a written request to the LLPVRC Board of Examiners and be current with your CEU requirements.  You may retire at any time during a renewal period and your CEU requirement can be prorated for you.  You are not required to submit CEUís while you are retired, but you must submit an annual renewal form and you are strongly encouraged to maintain current contact information.  

Rules of Implementation
Occupational standards section 705

B. A licensee may request retirement status if he is not going to engage in private practice for the next year or longer. Under retirement status the licensee would not be required to submit continuing education credits. If a retiree wishes to reactivate, he would need to do the following:

1. notify the board;

2. complete an application for reactivation;

3. pay the existing renewal fee;

4. begin documentation of continuing education hours.

C. A retiree cannot practice with a retirement status license. If the retiree holds a retirement status license for longer than five years and requests reactivation, he must pass the exam or show qualified continuing education hours for the previous two years.