Real Estate
2022
PROFESS I ONAL L I CENSURE & STATE AUTHOR I ZAT I ON D I SCLOSURE DETERMI NAT I ONS
REAL ESTATE H I NDS COMMUN I TY COL L EGE
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
National Professional Licensure Disclosure Template Mississippi Community College Board
Use this form to denote each of the states and territories for which the national licensure examination (i.e. nursing) leads to professional licensure. For any states and/or territories not selected, an individual State Professional Licensure Disclosure Template will need to be completed.
Program CIP CIP Number
Leads to Licensure
Leads to Licensure
Leads to Licensure
State/Territory
State/Territory
State/Territory
Alabama
Kentucky Louisiana
Ohio
Alaska
Oklahoma
American Samoa
Maine
Oregon
Arizona Arkansas California Colorado
Maryland
Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota
Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Connecticut Delaware
Tennessee
District of Columbia
Texas
Florida Georgia Guam Hawaii Idaho Illinois Indiana
U.S. Virgin Islands
Nevada
Utah
New Hampshire
Vermont Virginia
New Jersey New Mexico
Washington West Virginia
New York
North Carolina North Dakota
Wisconsin Wyoming
Iowa
Kansas
Northern Mariana Islands
Licensing Board Information Board Name Address City, State, and Zip Phone Number Website Reviewer Information
Name Email College Date of Review Reviewer Comments
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