Form A2 - Verification of Credentials

All new Category A and Category F applicants must complete and have notarized Form A2 in addition to the online application. Form A2 can be found as a downloadable PDF at the bottom of this page.

After submitting your online application, navigate to the Application Checklist by following the pink prompts for “status and required documents.” Next to the checklist item “Form A2” there is a blue “Upload” button. Use this function to upload an electronic copy of a completed and notarized Form A2.

Alternately, applicants may submit Form A2 to the Board office by email, fax, or postal mail.

Fax: 919-882-1776 
Mailing address: NCBDN, 140 Preston Executive Drive, Suite 205-C, Cary, NC 27513.

Download Form A2 PDF