EOHHS-DPH

Select Program(Required)

Radiation Control Program eLicensing Support

Food Protection Program eLicensing Support

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Your Name(Required)

First Last

Business/Organization Name(Required)

Do you have a license or Application Number?(Required)

Yes

License/Application Number(Required)

Email(Required)

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Phone(Required)

Question or Comment(Required)

Please do not provide any personal information (SSN, license/permit/ID number, date of birth, etc) in the Questions/Comments field. The required information on the form should be enough for us to research your case. If we need additional information, we will contact you.