| Licensing
Forms |
| Renewal
of current Kansas license |
PDF  |
License Renewal Application |
| Reinstatement
of previous Kansas license |
| PDF
|
Reinstatement Application (All
Professions) |
| (For LPN IV
Therapy Approval, please see Misc. Licensing Forms below.)
|
| Endorsement
from another state |
| PDF |
Endorsement Application (All
Professions) |
| PDF |
Endorsement
Verification Form (All Professions) |
| PDF |
Affidavit of Work Hours |
| (For LPN IV
Therapy Approval, please see Misc. Licensing Forms below.) |
| Request
Nursys Verification Request |
| Advanced
Practice |
| PDF |
Advanced Practice Application |
| Examinations
and Foreign Applications |
| Contact Licensing
785-296-2967 or
nickie.stallons@ksbn.state.ks.us |
| PDF |
Initial License |
| PDF |
Waiver Agreement
and Statement Fingerprint-Based Record Checks for Noncriminal
Justice Purposes |
| PDF |
Test Before Transcript |
| PDF |
Petition for Examination Test
or Retest |
| PDF |
Instructions for Foreign Nurses |
| PDF |
Special Petition for the Foreign
Nurse |
| Miscellaneous
Licensing |
| PDF |
Address Change |
| PDF |
Change of Name Certificate |
| PDF |
Duplicate License Affidavit |
| PDF |
IV Therapy Application |
| PDF |
Additional Wall Certificate
Order Form |
| PDF |
Additional ARNP Wall Certificate
Order Form |
| DEA
Form |
| PDF |
Controlled Substance Verification |
| Legal
Forms |
| Request
Risk Management Reporting Form |
| Disciplinary
Forms |
| PDF |
Nursing Performance Report Form |
| Education
Forms |
| PDF |
Individual Offering Approval
(IOA) |
| PDF |
Long-Term Provider Application
and Guidelines |
| PDF |
Single Program Application and
Guidelines |
| PDF |
LPN IV Therapy Course Provider
Application |
| PDF |
Clinical Facility Approval Request |
| PDF |
Faculty Qualification Report
(FQR) |
| PDF |
Faculty Degree Plan |
| PDF |
Faculty Hire Exception Form |
| PDF |
Major Curriculum Change Request |
| PDF |
Minor Curriculum Change Request |
| PDF |
Graduate Major Curriculum Change
Request |
| PDF |
Graduate Minor Curriculum Change
Request |
| PDF |
Preceptor List |
| PDF |
Simulation Scenario Library Form |
| PDF |
CNE Annual Report Form |
| Information
Request / Records Inspections Form |
| PDF |
Information Request / Record
Inspections Form |
| Other
Agency Forms |
| PDF |
Order the Nurse Practice Act |
| Don't see the form
you want? Submit a request
|
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