Online License Renewal Online Address Change License Verifiction Database
 
Search Our Site:
 • Forms
 • Nurse Practice Act
 • Agency Fees
 • Licensing Division

 • Education Division

 • Legal Division
 • Board Meetings
 • State Employment
 • Site Tools
 • Site Map
 • Contact Us

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

Home > Forms

Forms

- 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 APRN Affidavit of Hours Worked
(For LPN IV Therapy Approval, please see Misc. Licensing Forms below.)
Request Verification to another State
PDF PDF Request Verification of Kansas License to another State
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 Excelsior Students
(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
Contact Licensing 785-296-2967 or nickie.stallons@ksbn.state.ks.us
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
PDF PDF Special Petition for the Foreign Nurse
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)
PDF PDF Long-Term Provider Application and Guidelines 
PDF PDF Single Program Application and Guidelines
PDFPDF LPN IV Therapy Course Provider Application
PDFPDF IV Therapy Annual Report Form
PDFPDF Preceptor List
PDFPDF CNE 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
Don't see the form you want?   Submit a request

If you do not see the form you are looking for please let us know by visiting our Feedback Form. Please leave your contact information and which type of form you are looking for.

*All Forms Must be Printed and Submitted by Mail.

 

 

 

Notice

All forms on this web page are provided in Adobe Portable Document Format (.pdf)PDF. Please visit the Site Tools Download Center to get the necessary plug-ins to view these documents if you don't already have them.

*All Forms Below Must be Printed and Submitted by Mail.

 
 



© 2003 Kansas Board of Nursing.
Questions or Comments - Disclaimer