Applications and Forms - Mold Program

Texas Department of Licensing and Regulation (TDLR) Transition Plan

Senate Bill 202 became effective on September 1, 2015. That bill has mandated the Texas Department of State Health Services (DSHS) and the Texas Department of Licensing and Regulation (TDLR) develop a transition plan for the “orderly transfer of powers, duties, functions, programs, and activities”. This plan has been completed and is now in effect.  Several important steps in this plan will occur over the next several weeks related to the following programs:  Massage TherapyCode Enforcement OfficersSanitariansOffender EducationLaser Hair Removal, and Mold Assessment and Remediation.

  • As of October 13, 2017, licensees and applicants will not have access to VERSA Online, the online portal for licensing application and renewal, for programs which had this capability previously.  DSHS will cease initial licensing and renewal activities, and the application forms will no longer be available on the website.
  • As of October 20, 2017, DSHS will cease all licensing functions (including entry of new applications), in order to transmit licensing data to TDLR. This is necessary to ensure data integrity.
  • TDLR will begin licensing functions on November 1, 2017.  This means there will be a gap of approximately ten days during which neither agency will be able to perform licensing functions.  We apologize in advance for the inconvenience this may cause, but it is essential from a data standpoint.

In an effort to avoid renewal problems during this transition, a 90-day license extension has been granted to all licenses that expire in October, November, December. Updated license cards and/or letters indicating the new renewal date have been sent out to licensees that initially were to expire in October and November.  The December licensees will receive theirs shortly.

Please go to TDLR’s website for more information about the transition process.

The following applications and forms are available in either Word or PDF formats.

Please see the Department of State Health Services file viewing information for help with these file formats.

License Application Forms

Mold Licensing Application Forms
Form Name Word Acrobat
Mold Analysis Laboratory License Application Word (71KB) PDF (60KB)
Mold Assessment Company Word (77KB) PDF (51KB)
Mold Assessment Consultant Word (81KB) PDF (52KB)
Mold Assessment Technician Word (78KB) PDF (79KB)
Mold Company Duplicate License Application Word (67KB) PDF (32KB)
Mold Company Name Change License Application Word (68KB) PDF (33KB)
Mold Individual Duplicate Application Word (66KB) PDF (20KB)
Mold Individual Name Change License Application Word (82KB) PDF (33KB)
Mold Remediation Company Word (72KB) PDF (59KB)
Mold Remediation Contractor Word (81KB) PDF (51KB)
Mold Remediation Worker (registration) Word (75KB) PDF (57KB)

Training Provider Accreditation and Course Approval Packet

At least one course approval application must accompany an initial application for accreditation as a Mold Training Provider.

Forms for Mold Training Provider Accreditation Packet
Form Name Word
Mold Training Provider Accreditation Application Word (63KB)
Mold Training Course Approval Application Word (51KB)
Mold Training Instructor Reference Form Word (31KB)
Mold Training Course Roster Word (45KB)

Required Training Module on Potential Health Effects of Molds (PowerPoint presentation) (164K PowerPoint)

The information in this training module, developed by the Department of State Health Services (in consultation with state associations, including at least one representing physician) is required to be used by accredited training providers as part of the training protocol for mold assessment technicians, mold assessment consultants, mold remediation contractors and mold remediation workers, as per section 295.320 of the Texas Mold Assessment and Remediation Rules.

State Licensing Exams

Before applying for licensure as a mold assessment technician, mold assessment consultant, or mold remediation contractor, an individual must first take and pass a state exam. Please click on the links below for more information.

Upcoming Testing Dates and Information on Testing Procedures
Form Name Word Acrobat
Registration Form for State Exam Word (93KB) PDF (151KB)
Examination Calendar for 2016-2017
Word (99KB) PDF (120KB)
Final DSHS Mold Exam Schedule Sept-Oct 2017
Word (76KB)PDF (215KB)

Study Materials for State Exam (18K PDF)

Other Forms and Documents

Mold Remediation Notification Form (65K Word)

Certificate of Mold Damage Remediation (This link takes you to a Texas Department of Insurance webpage.)

Consumer Mold Information Sheet (107KB Word). Note:  Licensed mold assessors and remediators are required to provide a copy of this document to each client and to the property owner, if not the same person, before any mold-related activity begins. (This requirement does not apply to mold analysis laboratories or training providers).  

Complaint Form (53K Word) for reporting violations of the TMARR.

Last updated October 17, 2017