I am applying for my Illinois Surgical Assistant license; They need information from ABSA.

Please send an email to our office at: [email protected] including your name, address, certification number and that you are applying for Illinois Surgical Assistant License. Please attach a copy of the AFF-SA form with ONLY the top portion completed (ABSA will complete the middle and bottom portion). The ABSA will send documentation in a sealed envelope to you by mail. You will then attach the unopened “sealed envelope” to your license application. Note: The CT form does not need to be completed by the ABSA; This form is if you are a current US licensed physician, transferring your license from one state to another.