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West Virginia

RN Board

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Forms

Online Services:


RN License Reinstatement Application

RN Multistate Conversion Application (NEW)

Advanced Practice Initial and Reinstatement applications 

Prescriptive Authority Initial and Reinstatement applications


Printed forms:


RN applications

Endorsement Application (resulting in both temporary and permanent licensure)

 - OR - 

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

Exam Application Packet (must also complete Pearson Vue application) 

Retired Special Volunteer License  (law related to Volunteer License)

Charitable License Exemption Authorization (10-day)


Prescriptive Authority forms

Collaborative Agreement Form

Dissolvement of Collaborative Agreement


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:

 

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 $65.00
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

 

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