I've changed my name, how do I notify the Board?
A licensee, applicant or a certified nursing assistant who legally changes names must notify the Board in writing within 30 days of any name change. The applicant shall submit a copy of any official document evidencing the name change. Do not send original documents.
Provide documentation to verify license/certificate holder’s previous name (i.e. birth certificate, a social security card, marriage license, divorce decree, High School diploma) and documentation that verifies the licensee/certificate holder’s current name (i.e. divorce decree, driver’s license, social security card, marriage license).
Download the Name Change form from the Applications & Forms page (See Other Forms).