In addition to the application and fee, please submit the following documents:

1. Completed Application: Applications may be submitted online at MyLicense.IN.gov.  If you have ever held a license previously in Indiana, and are applying again for the same license type, please contact our office at (317) 234-2060 or by email at pla3@pla.in.gov to inquire about reactivating your previous license.
2. Application Fee of $50.00 - Pay by credit or debit card for applications submitted online.  All application fees are nonrefundable.
3. Criminal Background Check
4. Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s). Please upload at the time of application or log back into your account and use the License Update option.
5. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree.  Please upload at the time of application or log back into your account and use the License Update option.
6. Verification of other state licenses - an applicant who currently holds, or has previously held, a license, certification, or registration issued by another state to practice any health profession must request verification of license status from the state that issued that license, certification, or registration. The verification must be sent directly to the board from the agency that issued the license, certification, or registration. Official electronic verification will also be accepted.
7. Certified Professional Midwife Credential - a certified copy of CPM credential certificate or card conferred by the North American Registry of Midwives.  Please upload at the time of application or log back into your account and use the License Update option.
8. Postsecondary Diploma - a certified copy of diploma from postsecondary educational institution.  Please upload at the time of application or log back into your account and use the License Update option.
9. Original Postsecondary Transcript - where the applicant received a postsecondary degree, including the degree conferred and date conferred. Applicant must have either an associate's degree in nursing, midwifery (from MEAC approved program), or other similar science related degree; or, a bachelor's degree in any field. In lieu of this requirement and number 4 above, and prior to June 30, 2018, applicant may submit proof of enrollment directly from the institution of hearing learning.  Please upload at the time of application or log back into your account and use the License Update option.
10. Official MEAC-approved Program Transcript -  from a Midwifery Education Accreditation Council (MEAC) approved program showing completion of a MEAC approved midwifery educational curriculum. In lieu of this requirement, and prior to June 30, 2018, applicant may submit proof of 100 births where applicant was primary attendant (see Affidavit of Additional Births Form) and a letter of reference from a licensed physician with whom the applicant is collaborating.  Please upload at the time of application or log back into your account and use the License Update option.
11. CPR card - copy of certification in adult CPR that is not expired.  Please upload at the time of application or log back into your account and use the License Update option.
12. American Academy of Pediatrics certificate of completion or card - showing completion of program in neonatal resuscitation (excluding endotracheal intubation and drug administration).  Please upload at the time of application or log back into your account and use the License Update option.
13. Affidavit of Completion of Additional Births Form - submit as many affidavits as necessary to document completion of the following, which are in addition to any needed for CPM credentialing: (1) observation of 20 births; (2) attendance at 20 births conducted by a physician; (3) assistance with 20 births; (4) primary attendant at 20 births. All must have been in the United States and overseen by a NARM approved preceptor or physician. The document should be completed by the individual attesting to the additional births and notarized. Please upload at the time of application or log back into your account and use the License Update option.
14. Emergency Skills Training Course - certificate of completion of NARM approved emergency skills training course which is eligible for inclusion in the Midwifery Bridge Certification Program. The course(s) must include material on emergency life support procedures, identification of high-risk births for mothers, and identification of potential complications during labor.  Please upload at the time of application or log back into your account and use the License Update option.
15. Proof of Liability Insurance - must be a minimum of $100,000 per incident/$300,000 yearly aggregate.
16. Collaborative Practice Agreement - Please upload at the time of application or log back into your account and use the License Update option.

PROCESSING TIME: Processing time depends on the applicant. The applicant is responsible for the submission of all documents. If there is a positive response the license will not be issued until it has been reviewed by the Medical Licensing Board.

FAIR INFORMATION PRACTICE ACT: In compliance with IC 4-1-6, this agency is notifying all applicants that they must provide the requested information or the application will not be processed. The applicant has the right to challenge, correct, or explain information maintained by this agency. The information provided will become public record. Examination scores and grade transcripts are confidential except in circumstances where their release is required by law. A social security number is being requested by this state agency in accordance with IC 4-1-8-1. Disclosure is mandatory, and this record cannot be processed without it.

Renew Online!
All midwifery licenses will expire on March 31st of the odd years.

In addition, all midwives must make their annual report by March 31 of each year. The Annual Report Form can be found under the Resources section.

If you have a positive response to any of the renewal questions, you must submit a positive response statement by uploading the document in your account. Your license cannot be renewed until this information is received and, upon further review, additional information may be requested by the Committee.

Renewal notices are sent approximately ninety (90) days prior to the expiration date. License holders with valid e-mail addresses on file will be e-mailed the renewal notice. Those who do not have valid e-mail addresses on file will be mailed the license renewal notice; this notice is mailed to the address of record with the Committee. The Committee has no way of knowing whether or not a notice reaches its destination; therefore, when a notice has been e-mailed to a valid e-mail address or mailed, the duty of the Committee has been performed.

Midwifery Application/Renewal	Fee	Penalty	Total
Initial Application	$50	NA	$50
Active Renewal - Prior to March 31 of odd-numbered years	$50	$50	$100
Reinstatement	$100	NA	$100