State Licensure Form

1Select State

2Demographic Information Approval

3Payment

4Application

5Preview Application

Select the state for which you are applying for licensure.

If applying for Illinois licensure, please make sure you have the top portion of your AFF-SA form completed before submitting.

Select State *

Texas Surgical Assistant Licensure
Illinois Surgical Assistant Licensure
Washington DC Surgical Assistant Licensure

For Surgical Assistant Licensure in Tennessee, Colorado, and Nebraska, you should consult your case worker to determine what documentation they require ABSA to provide.

Please confirm your mailing address. Required documents will be mailed to you in a sealed envelope for you to attach to your application.

Certification Number

First Name *

Last Name *

Email *

Address Information

US or International

I live outside of the US

International Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mailing show

My mailing address is different

International Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Required Documents

Employment Verification Form *

Click or drag a file to this area to upload.

ABSA Statement on Personal and Professional Demographic Information.

Address Information

Required Documents

Payment