Criminal History Questionnaire (CHQ)

This form should only be used to submit a Criminal History Questionnaire(s).

Are you submitting a CHQ for a new or renewal license?*

Are you submitting a CHQ for an individual or business license?*

Note: If you are applying for both licenses a separate CHQ will need to be submitted for each type.

Select a TDLR Program*

The Entity number is found on the top right of the letter you received one from TDLR

TDLR ID/Entity Number

TDLR license number (if applicable)

Business name (if applicable)

First name*

Last name*

Social Security Number

Email address*

Phone number*

Please attach your completed Criminal History Questionnaire(s) (PDF)

Attachments (BMP, DOC, DOCX, GIF, JPEG, JPG, PDF, PNG, TIFF, XLS, XLSX)*

Drop files here, or browse to attach files

Confirmation Required

Are you sure you want to remove the selected file?

**Note: Max total upload size is 35MB. If your total attachment size is larger than 35MB, your email will not be received. You can submit additional files
by filling out this form again with the extra attachments.

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