Forms
Personnel/Mailing Address Change:
For online submission to request change(s) to current licenseee information:
Name Change Request:
For online submission to request name change not associated with change in ownership (changes of ownership require application for new licensure):
CRIMINAL HISTORY RECORDS (Background) CHECKS
Licensee facilities physically located in Louisiana:
A criminal history records (background) check is required for any individual person(s) who own greater than 10% interest in the licensee company and the designated responsible party (DRP) individual. Louisiana State Police has changed the process for criminal history record checks to an electronic fingerprint system. When applicable, such as a change of the DRP, have the individuals click the link below for instructions to apply for the required criminal history records check.