Volunteer and Retired Providers License Renewal
Volunteer and Retired Providers License Certification

This form serves to authorize the Washington State Department of Health to renew your healthcare license as a Volunteer and Retired Providers (VRP) Program volunteer.

Please complete the application below and include the notification of your license renewal prior to your license expiration date. You may upload your scanned renewal notice as either a .pdf or .jpg format. See “Choose File”.

Questions? Please contact either:

Washington Healthcare Access Alliance
vrp@wahealthcareaccessalliance.org

Office of Rural Health, Wa. Dept. of Health
ruralhealth@doh.wa.gov
360-236-2804
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