Applied Behavior Analyst Applications

• Application for Licensure as a Licensed Behavior Analyst or Licensed Assistant Behavior Analyst 
  
• Paper Application for Licensure as a Licensed Behavior Analyst or Licensed Assistant Behavior Analyst
  
• Declaration of Citizenship (PH-4183)
  
• Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
• Declaration of Eligibility for Expedited Licensure Process for a Spouse of Military Member (PH-4280)
• Name and Address Change Request   (PH-3619)
• Reinstatement Application  (PH-4049)
• Retirement Affidavit
• Criminal Background Check Instructions

When applying, please DO NOT email or fax documents to the administrative office.  All documents, including the initial application, must be received as an original document.  They must be sent by postal mail, overnight delivery (use zip code 37228), or hand delivered to the cash office of the Health Related Boards at 665 Mainstream Drive, Nashville TN 37243.  Thank you.