IDAHO DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSE
S
700 West State Street, Boise
ID 83702 or
P.O. Box 83720, Boise ID 83720-0063
Phone: (208) 334-3233 Fax: (208) 334-3945
Website: www.ibol.idaho.gov E-mail: ibol@ibol.idaho.gov
REQUEST FOR OFFICIAL LICENSE/REGISTRATION CERTIFICATION
Each state requires different
forms of certification of licensure. Please check with the state where you are
applying to see what is required before requesting certification from Idaho.
Certifications can be obtained two ways from Idaho:
1. Free primary source verification of license/registration status may be obtained via the web at
www.ibol.idaho.gov. Click on search licenses and registration. These certifications contain all public
information.
2. If the receiving state doesn’t accept web-based certifications or requires information exempt from third-party
disclosure (example: exam scores) to be included in the certification, use this form, which must include a
$10.00 fee.
Requestor Name: _______________________________________________________________________
Address: ______________________________________________________________________________
Street/ PO Box City State Zip
Phone number:_____________________ E-mail: ___________________________________________
I hereby make request for an official certification of license/registration # _____________.
Please ___ mail or ___ e-mail the certified document to:
Name: ________________________________________________________________________________
Email: ________________________________________________________________________________
Address: ______________________________________________________________________________
Street/ PO Box City State Zip
AFFIDAVIT
I hereby certify that I am the holder of the license/registration noted above and that by signing this form I
am authorizing the Division of Occupational and Professional Licenses to certify to my licensure or
registration and release of information that is not public record to the person or entity noted above.
Signature:__________________________________________________________ Date:______________
