INSTRUCTIONS FOR APPLYING FOR REGISTRATION WITH THE INDIANA PROFESSIONAL LICENSING AGENCY UNDER THE PROFESSIONAL CORPORATION ACT
APPLICATION FEE: $25.00
DOWNLOAD THE APPLICATION: https://forms.in.gov/Download.aspx?id=5662
Complete and return the application with a check in the amount of twenty-five dollars ($25.00) made payable to Professional Licensing Agency (PLA). A certificate of registration will be issued from PLA, which you must file with the Office of the Secretary of State (http://www.in.gov/sos/business/corps/searches.html) Indiana Government Center South Building, Room E018, Indianapolis, Indiana. Their phone number is (317) 232-6581. THIS APPLICATION DOES NOT CONSTITUTE A CERTIFICATE AND CANNOT BE USED FOR FILING WITH THE INDIANA SECRETARY OF STATE.
PLEASE NOTE: THE REGISTRATION PROCESS WILL NOT BE COMPLETE UNTIL THE PROFESSIONAL LICENSING AGENCY RECEIVES FROM THE PROFESSIONAL CORPORATION A COPY OF THE ARTICLES OF INCORPORATION CERTIFIED BY THE OFFICE OF THE SECRETARY OF STATE. We suggest that you submit an extra copy of the Articles of Incorporation to the Office of the Secretary of State for this purpose.
The corporate name must include the words “Professional Services Corporation” or “Professional Corporation” or an abbreviation of these words. Only a professional corporation in which all shareholders are physicians licensed under IC 25-22.5 may use the term "medical" in its corporate name.
A domestic professional corporation or a foreign professional corporation admitted to render professional services in Indiana:
shall have at least one (1) shareholder who is licensed in Indiana; and
may have at least one (1) shareholder who is licensed under the laws of another state to
render similar professional services.
Each proposed shareholder that is licensed in a state other than Indiana shall submit verification of licensure status from the other state(s). It must be sent to each state in which the practitioner (except those licensed in Indiana) holds a license. A certificate of registration cannot be issued until verification of licensure from the other state(s) is received.
Health care professionals who are licensed, certified, or registered by one of the following boards or committees are eligible to own shares in a professional corporation:
Board of chiropractic examiners (IC 25-10-1). State board of dentistry (IC 25-14-1). Indiana state board of health facility administrators (IC 25-19-1). Medical licensing board of Indiana (IC 25-22.5-2). Indiana state board of nursing (IC 25-23-1). Indiana optometry board (IC 25-24). Indiana board of pharmacy (IC 25-26). Board of podiatric medicine (IC 25-29-2-1).