Applications and Forms Notice Regarding Criminal Background Checks An applicant applying for a chiropractic license by examination or credentials is required by 12 AAC 16.030(7) or 12 AAC 16.033(10), respectively to submit an official criminal background check from all states in which an applicant has ever been licensed and from the primary residence state. Please note the following: Criminal background checks can come directly from the issuing agency to our office. Criminal background checks can come from the applicant if the report remains in its original, sealed envelope. The preferred method of receiving background checks is via hardcopy mail. Criminal background checks will be accepted via e-mail only if it can be verified that the sender e-mail belongs to a government e-mail address or similar authority. Some states do not allow distribution of criminal background checks to third parties or will not provide a report to the applicant if the intent is to forward it to a third party. If you have been licensed in a state that does not authorize the release of a criminal record report to a third party, please submit supporting documentation. Click here for an example of supporting documentation. Initial License Applications Chiropractic License by Examination #08-4952, New 01/08/2025 Chiropractic License by Credentials #08-4953, New 01/08/2025 Chiropractic Courtesy License #08-4500, Revised 10/11/2024 Application for out-of-state chiropractic physicians working at a special athletic, cultural or performing arts event in the State of Alaska. Chiropractic Locum Tenens Permit by Education or Examination #08-4964, New 03/05/2025 Application for out-of-state chiropractic physicians substituting in an Alaska-licensed chiropractic practice. Chiropractic Locum Tenens Permit by Credentials #08-4965, New 03/05/2025 Application for out-of-state chiropractic physicians substituting in an Alaska-licensed chiropractic practice. Renewal and Reinstatement Applications Chiropractic Physician License Renewal #08-0094, Revised 10/25/2024Do not submit your certificates with your renewal application. Only submit documentation of your continuing education activity if you are notified that you have randomly been selected for an audit. Chiropractic License Reinstatement #08-4170, Revised 03/05/2025 Application for reinstating a license that has been lapsed or in retired status for more than two years but less than five years. Licenses lapsed or in retired status for more than five years may not be reinstated. See the initial license application. Continuing Education Applications Continuing Education Course Approval for Chiropractors Use this form only if you are licensed in Alaska. #08-4640, Revised 01/08/2025 Continuing Education Course Approval for Providers #08-4003, Revised 01/08/2025 Miscellaneous Forms Chiropractic Specialty Designation Application Application to add a postgraduate specialty to an existing chiropractic license. #08-4061, Revised 03/05/2025 Request for Utilization Review #08-4371, Revised 03/05/2025 Application For Appointment to The Utilization Review Committee – Public Member Applicant #08-4967, Revised 03/05/2025 Application For Appointment to The Utilization Review Committee – Chiropractic Physician Applicant #08-4968, Revised 03/05/2025