Reciprocity / License Endorsement Request Form

Which reciprocity / license endorsement service are you requesting?

I understand that submitting this request and payment does not guarantee license endorsement, reciprocity approval, certification approval, DC HHA approval, DC TME approval, or acceptance by any licensing authority. I understand that Jireh Healthcare Institute must review my documents and that I am responsible for any third-party application, background check, fingerprinting, or state licensing fees. I confirm that the information and documents I submit are true and accurate.