Forms

Consumers

Document Title
Customer Service Evaluation Form

Applicants

Document Title
Application for Approval as a Continuing Education Provider
Application for California Public Health Nurse Certificate
Application for Clinical Nurse Specialist (CNS) Certification
Application for Licensure by Examination
Application for Licensure by Examination (8-Year Retake)
Application for Licensure by Endorsement
Application for Nurse Anesthetist (NA) Certification
Application for Nurse-Midwife (NM) Certification
Application for Nurse Practitioner (NP) Certification
Application for the Listing as a Psychiatric/Mental Health (P/MH) Nurse
Change of Address
Notification of Name Change
Notification of Social Security Number Change
Nurse Midwife Furnishing Number Application
Nurse Practitioner Furnishing Number Application
Online Clinical Nurse Specialist Applicant Identification Form
Online Examination Applicant Identification Form
Online Licensure by Endorsement Applicant Identification Form
Online Nurse Anesthetist Applicant Identification Form
Online Nurse-Midwife Applicant Identification Form
Online Nurse-Midwife Furnishing Number Application Identification Form
Online Nurse Practitioner Applicant Identification Form
Online Nurse Practitioner Furnishing Number Application Identification Form
Online Public Health Nurse Applicant Identification Form
Online RN Request for Repeat/Reapply Examination Identification Form
Request for Accommodation of Disabilities
Request for Authorization to Practice Without a California License at a Sponsored Free Health Care Event
Fingerprint Request for Live Scan
Request for Reapply/Repeat Examination
Request for Transcript

Education

Document Title
Continuing Approval - Nursing Program
New School of Nursing - Feasibility Study Report
Request for Major Curriculum Revision

Licensees

Document Title
Active to Inactive License
Application for Reinstatement of a Lapsed License - 8-Year Renewal
Change of Address
Continuing Education Certification
Continuing Education Provider Initial Renewal Notice
Fingerprint Request for Live Scan
Inactive to Active License
License Discipline/Conviction Certification
License Renewal - Delinquent
License Renewal - Timely
Notification of Name Change
Notification of Social Security Number Change
Renewal Fingerprint Question Certification
Request for Duplicate License

Enforcement

Document Title
Complaint
Expert Witness Application
Quarterly Report
Report of Settlement, Judgment, or Arbitration Award

Intervention

Document Title
Application for Nurse Support Group Facilitator/Co-Facilitator
Intervention Evaluation Committee (IEC) Application