Have you ever withdrawn an application for a permit or license (other than one to practice law), been denied a permit or license, had a permit or license revoked, and/or voluntarily surrendered a permit or license for any reason, and/or have you ever been the subject of any complaints, proceedings, investigations, or inquiries relating to a profession for which licensure is required that involved: allegations of unauthorized practice, censure, removal, suspension, revocation of license, discipline, and/or any other formal or informal charges, by any agency, organization or individual?
If you answer "Yes" to this question, you must provide a detailed explanation regarding the withdrawal, denial, revocation and/or voluntary surrender of your application, permit or license. Please provide a separate explanation for each incident. Additionally, you must send the Board office copies of all relevant documentation regarding the circumstances and/or disposition.