Application for Postgraduate Training License

Session Time Remaining

If you will be away from your computer for any period of time after starting your online application, it is strongly advised that you click on the "Save for Later" button located at the bottom of each page to minimize the risk of losing the application data that you have already input into the system. You can then log back into the application at a later time by clicking on "Continue Saved Application" located in the New Applicants section.

Military


Are you active military?	Yes	No


Please upload a copy of your military ID. Click here for recommendations on uploading files.


Are you the spouse of an active member of the military?	Yes	No


Please upload a copy of your dependent military ID. Click here for recommendations on uploading files.


Are you coming to North Dakota on military orders?	Yes	No

Biographical Information


First Name:	Middle Name:	Last Name:	Title:
Maiden Name:	Gender:	Date of Birth:	Place of Birth: Please list city, state or province and country.
Height (feet):	Height (inches):	Weight (pounds):	Eye Color:
Hair Color:	Social Security #:	DEA Registration #:	Identifying Marks:

Other Names Used


First Name:	Middle Name:	Last Name:

Please use the Add button below to list additional names used.

Home Address


Address Line 1:
Address Line 2: Please include apartment or suite number with your street address.
City:		State/Province:	Zip/Postal Code:
Phone:	Email:		Cell Phone:

User Account Information

Create a user account with a username and password to use in accessing your saved application and online services.

Enter a username:

Create Password

Enter and confirm your password.

Passwords must be at least 8 (eight) characters in length and include at least 1 (one) uppercase letter, lowercase letter, number and special character.
Special characters allowed are @ ! $ % & * ( ) - [ ] { } , / : ?


Password:	Confirm Password: