Contents
Form Example
MASSAGE THERAPY LICENSING PROGRAM
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
P.O. Box 149347, Mail Code 1982
Austin, Texas
OUT OF STATE LICENSE VERIFICATION
The application for licensure as a Massage Therapist in the State of Texas requires this form to be completed by all State Boards where I hold or have ever held a license. My signature below is your authorization to release all information in your files, favorable or otherwise, regarding myself. Section I to be completed by applicant. Please type or print
clearly.
Applicant Name ___________________________________________ License Number __________________
Applicant’s Signature _______________________________________ Date ___________________________
Address __________________________________________________________________________________
P O Box or Street No. CityState Zip
Telephone Number (include area code) ______________________________ Date of Birth ________________
Section II. (Completed by
State of ___________________________________________. |
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This certifies that ____________________________________ is: |
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(Applicant’s Name) |
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Registered [ ] |
Certified [ ] |
Licensed [ ] as a ___________________________________________ |
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Current status of this license/license/certification is: |
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Active [ ] |
Lapsed [ ] |
Inactive [ ] |
Denied ** [ ] |
Suspended** [ ] |
Revoked** [ ] |
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Effective date of License/Registration/Certification________________________________________________
**Please attach a copy of the Findings of Fact and Decision and Order. License/Registration/Certification issued based on:
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Education Requirements |
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Endorsement/Reciprocity |
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State Examination |
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Grandfather Requirements |
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National Examination |
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Qualifications for licensure in this state are:
a.Total hours of education ________
b.Number of hours required in Swedish Massage ________
c.Number of hours required in Anatomy & physiology ________
d. |
Written examination required? Yes [ |
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No |
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e. |
Practical examination required? Yes [ |
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No |
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Please attach a copy of the current massage therapy requirements (rules) for your state. (If current rules have been sent to this office within the last 12 months, please disregard this request.)
I certify that the above information is correct and true. I have enclosed a copy of the requirements for this state. Name of Agency __________________________________ Address _________________________________
Signature ___________________________________ Typed Name __________________________
Title _______________________________________ Date ________________________________
(STATE SEAL)
DSHS Publication #
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Common mistakes
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Illegible handwriting: Filling out the form in a way that is difficult to read can lead to processing delays.
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Missing signature: Not signing the form can result in immediate rejection of the application.
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Incorrect license number: Entering the wrong license number can cause confusion and may delay verification.
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Incomplete information: Omitting required fields, such as date of birth or address, can prevent the application from being processed.
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Failure to attach necessary documents: Not including copies of supporting documents, such as the Findings of Fact and Decision and Order, can lead to delays.
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Incorrect state information: Listing the wrong state in Section II can result in the form being sent to the wrong licensing authority.
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Not checking the current status: Failing to accurately indicate the current status of the license can create misunderstandings.
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Using outdated forms: Submitting an older version of the form may not comply with current requirements.
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Ignoring instructions: Not following the specific instructions provided in the form can lead to errors in the application process.
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Providing inaccurate education details: Misrepresenting the total hours of education or specific course hours can jeopardize the application.
Key takeaways
When filling out and using the Massage License Texas Lookup form, it is essential to keep the following key takeaways in mind:
- Clear Completion: Ensure that all sections of the form are filled out clearly and accurately. Use block letters for legibility, especially in the applicant's name and address.
- Authorization: By signing the form, the applicant authorizes the release of all relevant information from previous licensing authorities. This includes both favorable and unfavorable information.
- Out-of-State Verification: The form must be completed by the out-of-state licensing authority. This verification is crucial for applicants who have held licenses in other states.
- Attach Required Documents: Applicants must attach necessary documents, such as a copy of the findings of fact and decision order for any denied, suspended, or revoked licenses, as well as the current massage therapy requirements from their state.
- Keep Copies: It is advisable to keep copies of all submitted documents and the completed form for personal records. This can be helpful for future reference or in case of any discrepancies.
Steps to Using Massage License Texas Lookup
After gathering the necessary information, you can proceed to fill out the Massage License Texas Lookup form. This form requires details about both the applicant and the licensing authority. Follow these steps to ensure that you complete the form accurately.
- Begin with Section I, where the applicant must fill in their name, license number, and signature.
- Write the date next to the signature.
- Provide the applicant's address, including the P.O. Box or street number, city, state, and zip code.
- Include the applicant's telephone number with the area code.
- Enter the applicant's date of birth.
- Move to Section II, which is to be completed by the out-of-state licensing authority.
- Fill in the state where the applicant is licensed.
- Write the applicant's name in the designated space.
- Check the appropriate box to indicate whether the applicant is registered, certified, or licensed.
- Specify the type of license the applicant holds.
- Indicate the current status of the license by checking the appropriate box (active, lapsed, inactive, denied, suspended, or revoked).
- Provide the effective date of the license, registration, or certification.
- Check the boxes that apply regarding the basis for the license/registration/certification.
- Complete the qualifications for licensure in the state, including total hours of education and specific hour requirements for Swedish massage and anatomy & physiology.
- Indicate whether a written or practical examination is required.
- Attach a copy of the current massage therapy requirements for the state, if applicable.
- Finally, the licensing authority must certify the information by signing and dating the form. Include the name of the agency and the typed name and title of the signer.