Applications, Forms & Instructions

The following forms are in PDF format. You will need Adobe Acrobat Reader to view, download, or print.

For those individuals wishing to become credentialed in Kentucky as a Physical Therapist or Physical Therapist Assistant, please print the instructions, application form, HIV/AIDS Instructions, and other necessary forms.  You may also call or email the office to have an application package mailed to you.

To renew or reinstate your Kentucky license/certificate:

Reinstatement To Do List (PDF-39.8KB) A checklist for reinstatement.

Renewal & Reinstatement Application (PDF-44.5KB)

CEU Tracking Form 2013 (PDF-8KB) Track your continued competency credit hours; required for reinstatement of licensure.

HIV/AIDS Requirement (PDF-97KB)

Verification Form (PDF-77.5KB) This form is to request verification of your PT/PTA credential from another state licensing board to be sent to the KY Board of Physical Therapy.
Other State Boards Address and telephone numbers of other physical therapy licensing jurisdictions.

NPTE FIXED DATE TESTING

www.fsbpt.org Online exam registration with the FSBPT

ENDORSEMENT--Applicants who are already licensed/certified in another licensing jurisdiction:

Instructions (PDF-23.4KB)
Application (PDF-148KB)
HIV/AIDS Instructions (PDF-97KB)
www.fsbpt.org  FSBPT Score Transfer
Verification Form (PDF-77.5KB) This form is to request verification of your PT/PTA credential from another state licensing board to be sent to the KY Board of Physical Therapy.
Other State Boards Address and telephone numbers of other state PT Boards.

NPTE FIXED DATE TESTING

Foreign Educated Exam Instructions (PDF-38KB)
To Do List (exam candidates only)
HIV/AIDS Instructions (PDF-97KB)
Application (PDF-148KB)
Foreign Educated Endorsement Instructions (PDF-42KB)
Foreign Educated Supervisory Form
Clinical Skills Evaluation - Foreign Educated
Verification Form (PDF-69KB)
www.fsbpt.org Online exam registration with the FSBPT

KRS 327.060 Statute for Licensing Requirements for Foreign Educated
201 KAR 22:070 Regulation for Foreign Educated

Information on Foreign Credentialing Agencies accepted by the KY Board can be found under Resources.

Change of Address form  For home address change or physical therapy worksite change, print this form and mail or fax to board office. For a name change, mail or fax a copy of the legal document authorizing the change to the board office. Your records will be changed in-house.  

Wallet Cards - $15.00

Wall Certificates $25.00 

Other State Boards Address and telephone numbers of other physical therapy licensing jurisdictions.

Verification Request (PDF-16KB) Do you need to verify your KY PT/PTA credential to another agency? Please submit a signed request to the board office along with the fee of $20.00 for each verification. 

If you have questions regarding any of the above or need clarification, please feel free to email the board office at KYBPT@ky.gov or call the office at (502) 429-7140.