Chiropractic Clinical Assistant Application and Exam Registration for Certificate of Competency

I hereby apply for certification as a Certified Chiropractic Clinical Assistant per N.C.G.S. 90-143.4, and along with this completed application/registration, and delivery to the Board office of the required documentation outlined below, I agree to pay the $20 application fee required by the NC State Board of Examiners.

1. Upload a copy of your High School Diploma or High School Transcripts or GED or equivalent. (See below)
2. Upload a copy of your Driver’s License or Birth Certificate.(See below)
3. Attestation of Good Moral Character. This portion of the application form should be completed by a person who knows you but is not related to you, such as an employer, teacher, minister, neighbor, etc. You will provide an email address at the bottom of the application for the person you would like to complete the form on your behalf.(See below)

These documents can also be faxed to us at 704-793-1385 or emailed to john@ncchiroboard.com.