Prescriptive Authority forms
Collaborative Agreement Form
Dissolvement of Collaborative Agreement
Guidelines for Completing Collaborative Agreement Form
Dialysis Tech Forms
Dialysis Tech Applicant Employment Certification Form
Dialysis Tech Applicant Good Moral Character Certification Form
Dialysis Tech Applicant Program Administrator Competency Form
Other Forms
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 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 | $90.00
|
| Advanced Practice Application | $35.00 |
| Advanced Practice Renewal | $90.00
|
| 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 |