West Virginia
Board of Respiratory Care
Practitioner Account

Practitioner Information - NEW LICENSE REQUEST

User Name: * <-- This must be a valid email address.
Password: * 
Question: <-- You will be prompted with this when changing your password.
Answer: <-- This must be your response when asked the above question.
Last Name: * First Name: *  Last 4 SSN: 
Work Phone: Home/Cell Phone:
Address: *    County:  *
City: *    State:  *    ZIP:  *   
Highest Degree: *  From:    Graduated On:   
Employer: *
BoRC License #: *  Type: *  Initial License Date:  as of
Attach a file:    Required Documents

License History

Continuing Education

Disciplinary Actions