Virginia Board of Nursing
Forms & Applications
The below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000 to view and print DHP's documents.
Licensed Practical Nurse
Please Note: Click here to determine if your original state of Licensure requires the Nursys form for verification. Click here to use the Nursys online verification system.
Licensure by Examination - Practical Nurse
Application and Instructions for Licensure by Examination as a Practical Nurse
To obtain information regarding the NCLEX Examination, please visit the Pearson VUE website at www.vue.com
Application and Instructions for Licensure by Examination for LPN's Educated in Other Countries
Licensure by Repeat Examination - Practical Nurse
Application and Instructions for Licensure by Repeat Examination as a Practical Nurse
To obtain information regarding the NCLEX Examination, please visit the Pearson VUE website at www.vue.com
Reinstatement Applications - Practical Nurse
Application and Instructions for Reinstatement of License as an LPN
Declaration of Primary State of Residence Form
Registered Nurse
Please Note: Click here to determine if your original state of Licensure requires the Nursys form for verification. Click here to use the Nursys online verification system.
Licensure by Examination - Registered Nurse
Application and Instructions for Licensure by Examination as a Registered Nurse
To obtain information regarding the NCLEX Examination, please visit the Pearson VUE website at www.vue.com
Licensure by Repeat Examination - Registered Nurse
Application and Instructions for Licensure by Repeat Examination as a Registered Nurse
To obtain information regarding the NCLEX Examination, please visit the Pearson VUE website at www.vue.com
Reinstatement Applications - Registered Nurse
Application and Instructions for Reinstatement of License as a Registered Nurse
Declaration of Primary State of Residence Form
Get more information on the Nurse Licensure Compact
Clinical Nurse Specialist
Application and Instructions for Registration as a Clinical Nurse Specialist
Application for Reinstatement of Registration as a Clinical Nurse Specialist
Nurse Practitioner
Application and Instructions for Licensure as a Nurse Practitioner
Application and Instructions for Prescriptive Authority for Licensed Nurse Practitioners
Memo on Expanded Prescriptive Authority
Prescriptive Authority for Licensed Nurse Practitioners - Practice Agreement
Application for Reinstatement of License as a Nurse Practitioners
Application for Reinstatement of Prescriptive Authority
Massage Therapist
Application and Instructions for Certification as a Massage Therapist by Examination
Application and Instructions for Certification as a Massage Therapist by Endorsement
Application for Reinstatement of Certificate as a Massage Therapist, rev. 2/2005.
Certified Nurse Aide
Application and Instructions for CNA by Endorsement
CNA Reinstatement Application and Instructions
Application and Instructions for Certification as an Advanced Certified Nurse Aide
Application and Instructions for Reinstatement of Advanced Nurse Aide Certification
Medication Aide
Application to Establish a Medication Aide Training Program
Endorsement:
Instructions for Filing an Application for Registration by Endorsement for Medication Aides
Application for Registration by Endorsement as a Medication Aide
Examination:
Instructions for Filing an Application for Registration by Examination for Mediation Aides
Application for Registration by Examination as a Medication Aide
Candidate Information Bulletin from PSI
Link to PSI's website for examination information
Reinstatement:
Instructions for Fililng an Application for Reinstatement as a Medication Aide
Application for Reinstatement of Medication Aide Registration
Volunteer Practice Forms
Volunteer Practice Sponsor Form
Application for Registration for Volunteer Practice
Nursing Education Program
Application to Establish a Nursing Education Program
Survey Visit Report Forms for Education Programs
Survey Visit Report Form and Agenda for Registered Nurse Education Programs
Survey Visit Report Form and Agenda for Licensed Practical Nurse Education Programs
Compliance Forms & Information
Self Report Form
Certified Nurse Aide Self Report Form
Performance Evaluation Form
Nursing Performance Evaluation
Certified Nurse Aide Performance Evaluation
Miscellaneous Forms
Drug Log for Prescribers (.xls)
Employer Notified of Board Order
Prescriber Report to Board of Drugs or Prescription Given to Licensee
Recovery Support Group Attendance Log
Approval Forms