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  • Section I: If you are applying for a limited permit, complete this section before having your prospective employer complete Section II. Be sure to sign and date item 9.
  • Section II: Have the Clinical Laboratory Director who will be your general supervisor complete Section II.

Return the completed form with the $50 fee to the Office of the Professions at the address at the end of the form.

You may apply for a limited permit by submitting the Application for Limited Permit (Form 5) and limited permit fee of $50 at the same time or any time after you submit your Appliclication for Licensure (Form 1), licensure and first registration fee, and evidence of satisfactory education.