Update Your Contact Information Online

Completion of this form will generate an email message to board staff who will respond with a confirmation once the requested address information has been updated. This form may be used by all applicants, licensees, and those responsible for Certificates of Authorization for business entities. If you do not receive an email confirmation within three business days then you may wish to submit another form or e-mail ksbtpadmin@ks.gov for assistance.

You may also update your contact information by submitting a paper form found here

Required fields are marked with an asterik (*).

Your Information

Please enter your legal name. If you are submitting changes for a Certificate of Authorization please also list your title within the business, e.g. "Principal" or "Office Manager."
* Profession:






If none, please enter NONE
Select a choice


Select a choice


* Preferred Mailing Address:

New Home Address (if applicable)

New Business Address (if applicable)

 



The licensee shall notify the board in writing of any change of address within 30 days after the date of such change. (K.S.A 74-7025)

By submitting this form I certify under penalty of perjury under the laws of the State of Kansas that the information provided on this form is true and correct and that I am licensed to practice in the State of Kansas.