Board of Funeral Directors and Embalmers
Forms
The below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000 to view and print DHP's documents.
Funeral Service Provider
Checklist for Completing an Application for a License to Practice Funeral Service
Funeral Service Provider Application - revised 5/8/2013
Verification of State Licensure Form
Funeral Service Intern
Checklist for Funeral Service Internship Program
Application for Funeral Service Internship Program - revised 5/8/2013
Funeral Supervisor Registration Application - revised 5/8/2013
Internship Report Form(s)-1st 1000 hrs
Internship Report Form(s)-2nd 1000 hrs
Internship Report Form(s)-3rd 1000 hrs
Funeral Service Intern Hours - Attestation Form - 1st, 2nd and 3rd Report
Application for Change of Supervisor - Funeral Service Internship Program - revised 5/8/2013
Courtesy Card
Application for Courtesy Card - revised 5/8/2013
Establishment Forms
Application for Crematory Registration - revised 5/8/2013
Application for Surface Transportation and Removal Service - revised 5/8/2013
Application for Notification of Establishment Changes - revised 5/8/2013
Establishment Application (New Establishment, Branch Establishment or Change of Ownership w/ Re-inspection) - revised 5/8/2013
Application for Waiver of Full-Time Manager Requirement - revised 5/8/2013
Application for Renewal for Waiver of Full-Time Manager Requirement - revised 5/8/2013
Application for Change of Manager - revised 5/8/2013
Request for Reinspection due to Structural Change to Preparation Room - revised 5/8/2013
Continuing Education Forms
Application for Approval as a Continuing Education Provider
Continuing Education Experience Summary Form (includes instructions)
CEU Provider Request for Additional Courses
Continuing Education Provider Renewal Application
Reinstatement
Application for Reinstatement as a Funeral Service Provider - revised 5/8/2013
Application for Reinstatement as a Funeral Service Provider after Disciplinary Action - revised 5/8/2013
Application for Reinstatement as a Funeral Service Intern - revised 5/8/2013
Application for Reinstatement of Funeral Establishment - revised 5/8/2013
Application for Reinstatement of a Courtesy Card - revised 5/8/2013
Application for Reinstatement of Crematory Registration - revised 5/8/2012
Application for Reinstatement of Surface Transport and Removal Service - revised 5/8/2013
Continuing Competency
Continued Competency Activity and Assessment form