(Revised 1/1/08 ML 3118)
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A provisional license shall be issued only to an applicant who has in writing waived:
The right to a written statement of changes as to the reasons for the denial of an unrestricted license; and
Waived the right to an administrative hearing, in the manner provided in the North Dakota Century Code chapter 28-32, concerning non-issuance of an unrestricted license.
Any provisional license issued shall be accompanied by a written statement of the violations signed by the regional director of the Human Service Center or their designee and, in writing acknowledged by the applicant/provider.
Copies of the provisional license must be sent to the County Social Service Agency and the Division.
This form may be duplicated.
