KANSAS STATE BOARD OF NURSING

LANDON STATE OFFICE BUILDING

900 SW JACKSON, SUITE 1051

TOPEKA, KS 66612-1230

 

FINGER PRINT CARD

ORDER FORM

 

Name and complete address required to mail out a card, all incomplete submissions will be discarded. The telephone number and email address are optional and only used if we need to contact you about the finger print card order.

Attestation
I realize that this application is a legal document and by pressing the Submit button you are declaring under penalty of perjury under the laws of the State of Kansas that the information I have provided is true and correct to the best of my knowledge.
If all the above information is correct please press the Submit button .
Otherwise please go back and correct any information that is necessary.