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Provisional Licensure Application

Application for Provisional Licensure

Advisory Board for Interpreters for Interpreters between Hearing Individuals and Individuals who are Deaf, Deafblind, Hard of Hearing or Oral Deaf Application and Renewal for Provisional Licensure. Please allow up to 3 weeks for processing. If you are viewing this form from a mobile device, you may have to switch your browser to “Desktop Mode/View” to submit the form.

Are you intending to fill out the application for an Arkansas Provisional License?
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Occupational Licensing of Uniformed Service Members, Veterans, and Spouses.

Pursuant to Act 135 of 2021, ADH shall grant such automatic licensure upon receipt of payment of the initial licensure fee; evidence that the individual holds a substantially equivalent license in another state; and evidence that the applicant is a qualified applicant as shown above in 1, 2, 3 or 4.(Required)

Initial Licensure Fee Waiver

Pursuant to Act 725 of 2021, an applicant may receive a waiver of the initial licensure fee if, eligible. Eligible applicants are applicants who meet criteria as shown above in 1, 2, or 3 and provide documentation showing their receipt of benefits from the appropriate State Agency.(Required)
Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.

Note: Copies of all credentials held MUST be submitted along with this application. Credential(s) must show an expiration date and must be valid at the time of the application.] to [Note: Copies of all credentials held for the current application year MUST be submitted along with this application. Credential(s) must show an expiration date and must be valid at the time of the application.

Statements of adherence to ethical practices:

A Licensed Qualified Interpreter must abide by the Professional Code of Conduct promulgated under these Rules and stated in Ark. Code Ann. § 20-14-805(b)(9). By signing this document, I agree to adhere to the ethical practices stated in the Professional Code of Conduct and Ark. Code Ann. § 20-14-805(b)(9). I further confirm that all information contained above is true and accurate.

Reduced application fees for 2024 license year indicated below:

Online Payment? Visit the online payment page, follow directions, print receipt. Otherwise, please mail your payment to the below address: Arkansas Department of Health 4815 West Markham Street, Slot 29 Little Rock, AR 72205

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