Board of Nursing Forms and Other Documents
Forms and Publications for the NH OPLC Board of Nursing
Important Information for all Licensees
- New Hampshire has a mandatory licensing law. No person may practice as a nurse or nursing assistant without a license. The Board of Nursing defines "practicing" as including attendance at orientation or completing other types of non-director care activities.
- All completed, signed forms are legal documents and must be reproduced as they appear.
- Most license applications may be completed using the online licensing system as opposed to the "paper forms" below.
General Instructions for Forms
- Please use quality paper for printing the applications (white 8 1/2 x 11 inch paper must be used).
- Be sure that the form prints completely, making sure that all text is legible, and all boxed content, seals and symbols are displayed.
- Respond to all questions and fill in all requested information.
- Note: If the answer is none or N/A, please state so. Applications not completely filled out will be returned to you as incomplete.
- Be sure to sign and date the and include the correct application fee.
Advanced Practice Registered Nurse
- APRN Application for Initial Licensure
- How to Obtain a Criminal Background Check
- APRN Address and Name Change Form
- Application for License Reinstatement: Advanced Practice Registered Nurse (A.P.R.N.)
- Application for License Renewal: Advanced Practice Registered Nurse (A.P.R.N.)
Licensed Nursing Assistant Licensure Applications
- LNA Application for License by Endorsement
- LNA Initial Application by Competency Evaluation and Comparable Education
- LNA Reinstatement Application
- LNA License Renewal
- LNA Audit
- Medication Nursing Assistant Certification Application
- MNA Renewal
- MNA Reinstatement Application
- Criminal Background Check
Education Programs: Nursing Assistant and Medication Nursing Assistant
- Initial program approval documents: Contact board of nursing office 603 271 2323 and ask to speak with the LNA/MNA Clinical Program Specialist
- Educator/Faculty Approval
- Clinical Site Approval (Cooperating Agency)
- LNA Program Clinical Facility Site Visit Criteria Attestation
- Application for Approval of Cooperating Agency
- LNA Competencies and Skills
- Provide copy of the clinical agreement for board office records
- Provide a copy of the Current Facilities Inspection Report available online at URL: https://forms.nh.gov/licenseverification/
- Site Visit Documents
- Forms for students/graduates
Education: Pre-Licensure RN, LPN, and Out of State Programs
- Initial program approval documents: Contact board of nursing office 603 223 0305 and ask to speak with the LPN/RN Clinical Program Specialist
- Educator Faculty Approval
- Site Visit Rules Crosswalk
- Annual Report Forms – Contact board of nursing office 603 223 0305 and ask to speak with the LPN/RN Clinical Program Specialist.
- Educational Complaint Reporting
- Pre-Licensure Out of State/Distance Education - Required pursuant to Nur 602.15 (j)
- Online Distance Education or Post-Licensure Education
LPN IV Program Review Documents
- APRN Address/Name Change Form
- Clinical Practice Inquiry
- Declaration Primary State of Residency
- LNA Address/Name Change Form
- Nurse Audit
- Physician and Counselor Report
- RN, LPN, LNA Change of Name/Address
- Work Performance Report
- LPN Comparable Education Verification Form
- RN Comparable Education Verification Form
Registered Nurse / Licensed Practical Nurse Licensure Applications
- There is not a process for on-line submissions of License by Examination (NCLEX) applications at this time.
- The state criminal background check (Form DSSP 256 is available online) is the current form required for all nursing license by examination applicants during the State of Emergency. There is a $25 fee associated with the background check. Licensees receiving conditional licenses because of inability to obtain fingerprints/FBI background check will receive instructions regarding completion of the FBI criminal background check with fingerprinting after the conditional license is granted.
- The Board office is unable to 'hold' applications or money/checks in the event an incorrect form or fee was submitted.
- An applicant's signature on the single state criminal background check form (DSSP 256 Criminal History Record Information Release Authorization) may be notarized without being in the presence of the notary - please refer to the Governor's Emergency Order #11: Temporary authority to perform secure remote online notarization. The applicant will send the signed, notarized form to the Board of Nursing Office with the appropriate fee where we will process the payment and forward it on to the state police.
- License by Exam (Nur 303.02)
- RN and LPN License by Examination Application
- Criminal Background Check
*This form is not being used during current State of Emergency
- RN / LPN Request for Accommodations under the Americans for Disability Act
- Process for Retaking NCLEX Exam
- RN/LPN Temporary License for License by Exam
- NCLEX Remediation Guidelines
- License by Endorsement (Nurs 304.01)
- Foreign Educated Nurses (Nur 304.02 and Nur 304.03)
- Nursing License Renewal
- Nursing License Reinstatement
- Nursing Supply: A Georgetown University Study
- HRSA Report: Future Nursing Workforce Projections
- Board of Nursing Strategic Plan 2014