Request for a Copy of Original Certificate or License

If your original ALM Certificate or NCA license has been lost or destroyed, please complete the Request for a Copy of Original Certificate or License form. You will pay the $91.50 fee at nciapay.az.gov and select "Issuance Fee".  You will be emailed a receipt.  After you receive your receipt, please email your form and your receipt to [email protected]  **NOT USED FOR CAREGIVER CERTIFICATES**