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West Virginia

RN Board

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Forms

Online Services:


RN License Renewal Application
(NOTE - if you have a Multi-State license in another Compact state, then DO NOT RENEW your West Virginia license. You will be working on your Compact license while working in West Virginia.)
(Renewal period ends October 31, 2018)


RN License Reinstatement Application
(NOTE - because WV is now a Compact state, if you qualify for a multistate license then you will be issued a multistate license upon reinstatement. To qualify, you must obtain a background check. Please click here for instructions.)

RN Multistate Conversion Application (NEW)


Advanced Practice Initial and Reinstatement applications 
(NOTE - If you have a multi-state license from another state, we will need to enter your demographic information into our system before you are able to fill out the APRN application.  Please complete the APRN pre-application (link) and send it to the WV RN Board office.)


Prescriptive Authority Initial, Change and Reinstatement applications


Printed forms:


(This form must be completed by APRN applicants who hold a multi-state license from another state)

RN applications

RN License Endorsement Application (resulting in both temporary and permanent licensure)

 - OR - 

Endorsement Application (resulting in temporary 90-day license ONLY, non-renewable, no permanent license)

Retired Special Volunteer License  (law related to Volunteer License)

Charitable License Exemption Authorization a 10-day license exemption to work on a charitable project for no compensation)


Prescriptive Authority forms

Collaborative Agreement Form

Dissolvement of Collaborative Agreement

Guidelines for Completing Collaborative Agreement Form


Dialysis Tech Forms

Dialysis Tech Initial and Endorsement Application

Dialysis Tech Reinstatement Form


Other Forms

Lost or Duplicate License

APRN Verification Form
(Use this form to send to other states and have them verify your APRN license with us)

RN Verification Form
(Use this form to obtain a verification from states that do not participate in NURSYS)


Complaint Form

 

Fee Schedule:

 (there may be a small additional transaction fee for online applications)

Address Change No Charge
Duplicate License $10.00
Endorsement without Temporary Permit $100.00 (Money Order or Cashier's Check)
Endorsement with Temporary Permit $125.00 (Money Order or Cashier's Check)
Endorsement with 90-day Temporary Permit ONLY $25.00 (Money Order or Cashier's Check)
Licensure by Examination $70.00 (Money Order or Cashier's Check)
RN Renewal $67.00
Advanced Practice Application $35.00
Advanced Practice Renewal $35.00
Limited Prescriptive Authority $125.00
Name Change $10.00
Name Change with License Replacement $10.00
Reinstatement from Lapsed Status $115.00
Reinstatement from Inactive Status $25.00
Transcript Photocopy $5.00
Verification to Another Nursing Board
or Certification Body
via NURSYS
Volunteer License No Charge
Working Without a Valid License Disciplinary fees