Application Instructions

• Documents Required for Licensure
  1. Apply Online - Apply online at MyLicense.IN.gov.
  2. Application Fee - $100.00 payable via credit or debit card.  Additional online processing fees apply.
  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. Official Transcript - Please upload at the time of application or log back into your account and use the License Update option. Transcript to include your baccalaureate degree.
  7. Verification from the National Commission for Certification of Anesthesiologist Assistant (NCCAA) of the applicant's certification status
  8. 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.
  9. Practice Protocol Agreement- (see the  "AA Practice Protocol Checklist" at the top of this page for more clarification of the agreement requirements) Supervising physicians (or primary supervising physician of a physician group practice) must submit a practice protocol agreement that details the exact privileges and tasks the anesthesiologist assistant shall be performing under the physician's supervision. In addition, please give a detailed description of the process maintained for evaluation of the anesthesiologist assistant's performance. If you plan to attach a copy of the evaluation form to the agreement, you must specify in the agreement that you are doing so. This practice protocol agreement must be completely typed, on company letterhead, be person specific, and must include the anesthesiologist assistant's and supervising physician's name, (or primary supervising physician of a physician group practice),license numbers, the practice address, and be signed and dated by both the anesthesiologist assistant and the supervising physician, (or primary supervising physician of a physician group practice). If there are additional supervisors, their names and license numbers should be included as an addendum.     You may receive a license without a practice protocol submitted; however, the Board is currently reviewing all practice protocols.  You may not practice until the protocol is approved. 

  • AA Practice Protocol Checklist
  • AA Practice Protocol Agreement Sample
• Information Regarding Reciprocity
  • Licensure by Reciprocity: The Board shall issue a license to an applicant if the applicant satisfies the following conditions:
    • Holds a current license from another state or jurisdiction; and
      • that state's or jurisdiction's requirements for a license are substantially equivalent to or exceed the requirements for a license of the Board; or
      • when the person was licensed or certified by another state:
        • there were minimum education requirements in the other state or jurisdiction;
        • if there were applicable work experience and clinical supervision requirements in effect, the person met those requirements to be licensed in that state; and
        • if required by the other state or jurisdiction, the person previously passed an examination required for the license or certification.
    • Has not committed any act in any state or jurisdiction that would have constituted grounds for refusal, suspension, or revocation of a license, certificate, registration, or permit to practice that occupation in Indiana at the time the act was committed.
    • Does not have a complaint or an investigation pending before the regulating agency in another state or jurisdiction that relates to unprofessional conduct.
    • Is in good standing and has not been disciplined by the agency that has authority to issue the license or certification.
    • If a law regulating the applicant's occupation requires the board to administer an examination on the relevant laws of Indiana, the Board may require the applicant to take and pass an examination specific to the laws of Indiana.
    • Pays any fees required by the Board for which the applicant is seeking licensure.

Renewal Instructions

• Renewal Information

  Renewal is available online at MyLicense.IN.gov.

  • Anesthesiologist Assistant licenses expire October 31 of every odd-numbered year.
  • The renewal fee is $50.
  • If your license has expired, you will incur an additional $50.00 penalty for up to 3 years expired.

Change/Addition of Supervising Physician

• Change/Addition Information

  If there is a change in employment or physician group practice, the anesthesiologist assistant needs to complete and submit the Change/Addition of Supervising Physician Application, and a new practice protocol.  Additional instructions concerning practice protocols can be found in the AA Practice Protocol Helpful Documents section of the Application Instructions.

  If additional supervisors are added at a current place of employment or physician group practice, and the practice protocol for the anesthesiologist assistant at that place of employment has been approved, the names of the additional supervisors can be added as an addendum to the practice protocol.  The anesthesiologist assistant will need to complete the Change/Addition of Supervising Physician Application, but does not need to submit a new practice protocol.

  Anesthesiologist assistants adding or changing supervisors may continue practicing while this application is being processed.

  • Change/Addition of Supervising Physician Application

• Anesthesiologist Assistant Applications/Renewals

  Anesthesiologist Assistant Fees	Fee	Penalty	Total
  Initial Application	$100	NA	$100
  Active Renewal - Prior to October 31 of odd-numbered years	$50	$50	$100