Licensing Forms

TDMHSAS Licensing forms are available in both printable PDF and web-based formats.  Choose the version below that meets your needs and follow the directions on the form for submission.

Initial Application (Print)
Initial Application (Web-based)

Change of Status (Print)
Change of Status (Web-based)

Fact Sheet (Print)
Fact Sheet (Web-based)

Financial Statement (Print)
Financial Statement (Web-based)

Background Check and Non-Criminal Justice Privacy Rights  (Print)
Background Check and Non-Criminal Justice Privacy Rights (Web-based)

Reportable Incident (Print)
Reportable Incident (Web-based)

Incident Reporting Requirements (Word .doc download)