An official website of the State of Georgia government.
Here’s how you know
State government websites often end in .gov. Before sharing sensitive information, make sure you’re on a state website. Still not sure? Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia.
The https:// ensures that any information you provide is encrypted and transmitted securely.
To apply for initial licensure as a Clinical Perfusionist, please refer to the following documents:
General Information and Checklist
Initial Application Form
Form A - Affidavit of Applicant
Form B - Certification of Examination
Form C - Verification of Licensure/Certification
Form D - Certificate of Education
Form E - Reference Form
Form F - Provisional Statement of Supervision