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Landon State Office Building
900 SW Jackson Street
Suite 1051
Topeka, Kansas 66612-1230
Main: 785-296-4929
Fax: 785-296-3929

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- Licensing - Legal - DEA - Information Request Records Inspections
- Education - Other Agency Forms - Mailing List  

Licensing Forms
Renewal of current Kansas license
PDF PDF License Renewal Application
Reinstatement of previous Kansas license
PDF PDF Reinstatement Application (All Professions)
PDF PDF Affidavit of Work Hours
(For LPN IV Therapy Approval, please see Misc. Licensing Forms below.)
Endorsement from another state
PDF PDF Endorsement Application (All Professions)
PDFPDF Legal Issues Reference Packet
PDF PDF Endorsement Verification Form (All Professions)
PDF PDF Affidavit of Work Hours
(For LPN IV Therapy Approval, please see Misc. Licensing Forms below.)
Request Nursys Verification Request
Advanced Practice
PDF PDF Advanced Practice Application
PDF PDF Nurse-Midwife Affidavit
Examinations and Foreign Applications
PDFPDF Initial License
PDFPDF Waiver Agreement and Statement Fingerprint-Based Record Checks for Noncriminal Justice Purposes
PDFPDF Legal Issues Reference Packet
PDFPDF Test Before Transcript
PDFPDF Petition for Examination Test or Retest
PDFPDF Instructions for Foreign Nurses
Miscellaneous Licensing
PDF PDF Address Change
PDF PDF  Change of Name Certificate
PDF PDF  Duplicate License Affidavit
PDF PDF  IV Therapy Application
PDF PDF Additional Wall Certificate Order Form for any License
DEA Form
PDF PDF Controlled Substance Verification
Legal Forms
Request Risk Management Reporting Form
Education Forms
PDF PDF Individual Offering Approval (IOA)
Long-Term Provider Application and Guidelines 
Single Program Application and Guidelines
IV Therapy Provider Application
Long Term Provider Annual Report Form
PDFPDF IV Therapy Roster
PDFPDF IV Therapy Competency Checklist
PDFPDF Preceptor List
IV Therapy Annual Report Form
Information Request / Records Inspections Form
PDF PDF Information Request Form
Mailing Data List Request Form
WEBFORM Mailing Data List Request Form
Other Agency Forms
PDF PDF Order the Nurse Practice Act
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