Application Packets

Application Packets are available for download below.

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you have a current application to submit, and the likelihood of the application being returned to you, because it is outdated, will be greatly minimized.

Application Packet Downloads

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 Application by Endorsement or Examination

Certified Nursing Assistant Renewal Application

Certified Registered Nurse Anesthetist Certification Application

Nurse Practitioner/Clinical Nurse Specialist/Nurse Midwife Certification and Prescribing and Dispensing Privileges Application

Registered Nurse/Licensed Practical Nurse Application by Endorsement

Registered Nurse/Licensed Practical Nurse Application by Examination

Registered Nurse/Licensed Practical Nurse Renewal Application

School Nurse Certification Application

School Nurse Renewal Application

Other Form Downloads

Statement of Citizenship and Alien Status

Request for Temporary License/AP Certificate

Affidavit Regarding Social Security Number

Application for Reinstatement

Declaration of Primary State of Residence

Fingerprint Card Instructions

Name/Address Change, Duplicate License or Certificate/CNA Document

RN/LPN/CNA Invalid License Questionnaire

Questions & Answers

What are the licensure by endorsement application requirements for nurses educated in a foreign country, including Canada?

What are the licensure by examination application requirements for nurses educated in a foreign country, including Canada?

How do I obtain a mailing list of RN's, LPN's, and CNA's?

How do I change my address/name?

What do I do if my license is lost or stolen?

How much are the fees?