Board of Chiropractic Examiners 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 Physician License Application #08-0672, Revised 12/01/2020 Application and instructions for licensure by examination or for licensure by credentials. Chiropractic Physician Courtesy License Application #08-4500, Revised 07/23/2019 Application and instructions for out-of-state chiropractic physicians working at a special athletic, cultural, or performing arts event in the State of Alaska. Chiropractic Physician Application for Locum Tenens Permit #08-4319, Revised 11/08/2019 Application and instructions for out-of-state chiropractic physicians substituting in an Alaska-licensed chiropractic practice. Renewal and Reinstatement Applications Chiropractic Physician License Renewal Application #08-0094, Revised 12/14/2022 Chiropractic Physician License Reinstatement Application #08-4170, Revised 09/05/2018 Application and instructions for reinstating a license that has been lapsed or in retired status for more than two years but less than five years. Chiropractic Physician License Reactivation Instructions #08-4563, Revised 09/23/2016 Instructions and information for reactivating an inactive or retired status license. Please do 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. NOTE: 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 Application for Chiropractors Use this form only if you are licensed in Alaska. #08-4640, Revised 10/01/2016 Continuing Education Course Approval Application for Providers #08-4003, Revised 10/01/2016 Miscellaneous Forms Chiropractic Specialty Designation Application Application to add a postgraduate specialty to an existing chiropractic license. #08-4061, Revised 10/04/2010 Request for Peer Review #08-4371, Revised 09/26/2016 Application for Appointment to the Utilization Review Committee #08-4370, Revised 11/29/2016 Division forms may be found in the CBPL Quick Links, located in the sidebar to the right.