Request Access

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1. Fill out the form below.

2. Select the agencies to which you require access.

3. Wait for an email with approvals or denials for the requested agencies.

Note: If you already have a user account and want to request access to other agencies, log in to Elite and click System / Agency Name > Request Agency Access.
First Name
Middle Name
Last Name
Email Address
Username
State Licensure ID
Level of Certification
Agencies
Notes