Application Packets

Applications are revised periodically so do NOT request an application unless you intend on completing it within a 30 day period. This will help to ensure that you have a current application to submit, and the likelihood of the application being returned to you, because it is outdated, will be greatly minimized.

Applications will only be accepted if the original signed copy is submitted by postal mail or brought directly to our office for processing. Applications that are faxed or e-mailed will NOT be accepted.

Certified Nursing Assistant

• CNA Application by Endorsement (PDF)
• CNA Application by Examination (PDF)
• CNA Renewal Application (PDF)
• CNA Lapsed/Expired Certificate Questionnaire (PDF)

Registered Nurse & Licensed Practical Nurse

• RN/LPN Application by Endorsement (PDF)
• RN/LPN Application by Examination (PDF)
• RN/LPN Renewal Application (Online Renewal)
• RN/LPN Temporary License Application (PDF)
• RN/LPN Temporary License Application for Refresher Course ONLY (PDF)
• RN/LPN Late/Invalid License Questionnaire (PDF)
• RN/LPN Inactive Status Application (PDF)
• RN/LPN Retired Nurse Application (PDF)

Certified Medication Assistant

• CMA Application (PDF)
• CMA Renewal Application (PDF)

Advanced Practice

• Certified Registered Nurse Anesthetist Certification Application (PDF)
• Nurse Practitioner/Clinical Nurse Specialist/Nurse Midwife Certification and Prescribing & Dispensing Privileges Application (PDF)
• AP Temporary License Application (PDF)

School Nurse

• School Nurse Initial/Renewal Certification Application (PDF)

Other Form Downloads

• Affidavit Regarding Social Security Number (PDF)
• Affidavit Regarding Lawful Presence Documentation/Social Security Number For Foreign National Applicants Living Abroad (PDF)
• CNA Education Waiver Military or Foreign Graduate (PDF)
• CNA Education Waiver Nursing Student (PDF)
• Credit/Debit Card Authorization Form (PDF)
• Declaration of Primary State of Residence/Change of Address Form (PDF)
• Fingerprint Card Instructions
• Name Change/Duplicate License/Certificate Request (PDF)
• Re-Issuance For Persons Who License Has Been Revoked, Denied or Voluntary Surrendered (PDF)
• Citizenship and or Lawful Presence Cover Sheet/Alien Status Declaration/Lists A & B (PDF)

Questions & Answers

• What are the licensure by endorsement application requirements for nurses educated in a foreign country, including Canada? (PDF)
• What are the licensure by examination application requirements for nurses educated in a foreign country, including Canada? (PDF)
• How do I obtain a mailing list of RN's, LPN's, and CNA's?
• How do I change my address? (PDF)
• How do I change my name? (PDF)
• What do I do if my license is lost or stolen? (PDF)
• How much are the fees?