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Applying for Licensure 12 Months or Later After Program Completion

Download the Applying for Licensure 12 Months or Later After Program Completion Form (PDF)

Instructions:

• Students must apply for licensure within 12 months of program completion to meet current licensure standards.
• If it has been more than 12 months since program completion at 51±¬ÁÏ, the student must complete this form and foward it to the undergraduate or graduate program coordinator prior to applying for licensure.
  • For a list of undergraduate program coordinators, visit the Undergraduate Program Coordinators page on the EHHS website.
  • For a list of graduate program coordinator, visit the Graduate Program Coordinators page on the EHHS website.
• Once form is signed by the program coordinator and the necessary requirements specified on this form (if applicable) are complete, this form must be uploaded or emailed to Katie Kozak at kkozak2@kent.edu. The student can then apply for licensure by proceeding to the Licensure Pre-Application in the

Licensure Candidate: Fill out this box then forward the form to the program coordinator (see above).

• Name
• ID#
• Licensure Program was Complete: (Date)
• Licensure Area/Major

Program Coordinator: Student's transcripts must be reviewed to make sure all current state licensure requirements (Part 1) and current program requirements (Part 2) have been completed.

Part 1: Review of coursework based on current ODE State Licensure Standards

• Yes, additional coursework is required (see below for specified courses)
• No additional coursework is required
• Coursework Required

Part 2: Review of coursework to determine adequacy of content and methods based on current program requirements (complete this part only if it has been 6 years or longer since program completion).

• Yes, additional coursework is required (see below for specified courses)
• No additional coursework is required
• Coursework Required
• Total hours required for KSU to recommend student for licensure
• If coursework is required, contact the Registrar's Office at 330-672-3131 to reactivate your student file to register for coursework at 51±¬ÁÏ.
• Program Coordinator / Date
• Licensure Candidate / Date
• This form is valid for 12 months from your date of signature. All signatures are required for this form to be valid. After the 12 month period, a new form must be completed.

Last updated July 23, 2025