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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

Licensure by Endorsement – Practical Nurse

If you have graduated from an approved nursing education program and have been licensed by examination in another state within the U.S. or are scheduled to sit for the NCLEX in another state in the U.S., you will need to apply for licensure by endorsement.

If one or more apply to you, please contact the Board at (804) 367-4555:

  1. not a graduate of an approved school of practical nursing,
  2. licensed in another state on the basis of any type of nursing education program except a school of practical nursing,
  3. you are a Licensed Vocational Nurse and did not take the NCLEX,
  4. nursing education was received in a foreign country, or
  5. nursing education was received in another country, but the education prepared you for practice comparable to that of a registered nurse in this country.

Please read the application questions carefully before answering each question. If you need additional information, please read the Board of Nursing regulations governing nursing.

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.

Applications for licensure as a Licensed Practical Nurse by Endorsement or Examination are now exclusively accepted online. Click here to begin the online application process.

Please click here to read the Laws and Regulations governing the practice of Nursing.

License Verification Form

 

Licensure by Examination – Practical Nurse

If you are a recent graduate from a PN state approved nursing education program that prepared you to be a nurse and need to take the NCLEX (state board), you will need to complete the application for licensure by examination.
If one or more apply to you, please contact the Board at (804) 367-4555 for further assistance:

Please read the application questions carefully before answering each question. If you have any questions, please contact the Board of Nursing at 804-367-4555. For additional information, you may read the Board of Nursing regulations governing nursing on our website.

Applications for licensure as a Licensed Practical Nurse by Endorsement or Examination are now exclusively accepted online. Click here to begin the online application process.

Please click here to read the Laws and Regulations governing the practice of Nursing.

License Verification Form

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

Application and Instructions for Reinstatement of License as an LPN Following Suspension or Revocation

Declaration of Primary State of Residence Form

Get more information on the Nurse Licensure Compact

 

Registered Nurse

Licensure by Endorsement – Registered Nurse

If you have graduated from an approved nursing education program and have been licensed by examination in another state within the U.S. or are scheduled to sit for the NCLEX in another state in the U.S., you will need to apply for licensure by endorsement.

Canadian Nurses:
Canadian Nurses are eligible for endorsement if:

Foreign and Puerto Rico Nurses:
If your nursing education was received in another foreign country or Puerto Rico (did not take the NCLEX in Puerto Rico), please contact the board at (804) 367-4555 before filing this application.

Please read the application questions carefully before answering each question. If you need additional information, please read the Board of Nursing regulations governing nursing.

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.

Applications for licensure as a Registered Nurse by Endorsement or Examination are now exclusively accepted online. Click here to begin the online application process.

Please click here to read the Laws and Regulations governing the practice of Nursing.

License Verification Form

Licensure by Examination - Registered Nurse

If you are a recent graduate from a RN state approved nursing education program that prepared you to be a nurse and need to take the NCLEX (state board), you will need to complete the application for licensure by examination.

If one or more apply to you, please contact the Board at (804) 367-4555 for further assistance:

Applications for licensure as a Registered Nurse by Endorsement or Examination are now exclusively accepted online. Click here to begin the online application process.

Please click here to read the Laws and Regulations governing the practice of Nursing.

Notification of Intent to Supervise Provisional Licensee


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

Application and Instructions for Reinstatement of License as a Registered Nurse Following Suspension or Revocation

Declaration of Primary State of Residence Form

Get more information on the Nurse Licensure Compact

 

Clinical Nurse Specialist - Online Application

Applications for Registration as a Clinical Nurse Specialist are now accepted online. Click here to begin the online application process.


Reinstatement Application for Clinical Nurse Specialist

Application for Reinstatement of Registration as a Clinical Nurse Specialist

 

Nurse Practitioner Application - Online Application

Applications for Licensure as a Licensed Nurse Practitioner are now accepted online. Click here to begin the online application process.

NOTE:  If you already have a Nurse Practitioner license and you wish to add additional specialties, you will need to contact the Board of Nursing at (804) 367-4515 to have a paper Application for Licensure as a License Nurse Practitioner mailed to you.  You cannot use the online nurse practitioner application process to apply for additional specialties. 

Verification Form - Nurse Practitioner

Reinstatement Applications for Nurse Practitioner:

Application for Reinstatement of License as a Nurse Practitioner

Application for Reinstatement of License as a Nurse Practitioner following Suspension or Revocation

 

 

Authorization to Prescribe (Prescriptive Authority for Nurse Practitioners) - Online Application

Applications for Authorization to Prescribe (Prescriptive Authority) are now accepted online. Click here to begin the online application process.

NOTE: You will also need to submit an application for a Nurse Practitioner License, or already hold a current Nurse Practitioner License in order to apply for Authorization to Prescribe (Prescriptive Authority)

 

Reinstatement Application for Authorization to Prescribe (Prescriptive Authority):

Application for Reinstatement of Prescriptive Authority

Application for Reinstatement of Prescriptive Authority following Suspension or Revocation

 

 

Massage Therapist - Online Application

Applications for Registration as a Certification as a Massage Therapist by Examination and Endorsement are now accepted online. Click here to begin the online application process.


Reinstatement Application for Certificate as a Massage Therapist:

Application for Reinstatement of Certificate as a Massage Therapist

Instructions for Reinstatement of Certificate as a Massage Therapist following Suspension or Revocation

Application for Reinstatement of Certificate as a Massage Therapist following Suspension or Revocation

 

Certified Nurse Aide (Applications Cannot Be Faxed – Original Applications Must Be Sent to the Board)

(NNAAP) Click here to link to Promissorís website for information and an application to sit for the state Nurse Aide exam

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 (Applications Cannot Be Faxed – Original Applications Must Be Sent to the Board)

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 (pdf)

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 (Applications Cannot Be Faxed – Original Applications Must Be Sent to the Board)

Volunteer Practice Sponsor Form

Application for Registration for Volunteer Practice

Inactive to Active Status Request Form (RN and LPN)

Request Form for change of status from Inactive to Active (RN and LPN)

 

Nursing Education Program (Applications Cannot Be Faxed – Original Applications Must Be Sent to the Board)

Application to Establish a Nursing Education Program

 

Nurse Aide Education Program (Applications Cannot Be Faxed – Original Applications Must Be Sent to the Board)

Instructions and Application to Establish a Nurse Aide Education Program

Nurse Aide Education Program Skills Record

Nurse Aide Education Program Curriculum

 

Survey Visit Report Forms for Education Programs

Survey Visit Report Form and Agenda for Education Programs

NCLEX Survey Visit Report Form

 

Compliance Forms & Information

Compliance FAQs

Self Report Form

Nursing Self Report Form

Certified Nurse Aide Self Report Form

Generic Self Report Form

Registered Medication Aide Self Report Form

Performance Evaluation Form

Nursing Performance Evaluation

Certified Nurse Aide Performance Evaluation

Registered Medication Aide Performance Evaluation

Miscellaneous Forms

Drug Log for Prescribers (.xls)

Employer Notified of Board Order

Initial Contact Form (Form 1)

Prescriber Report to Board of Drugs or Prescription Given to Licensee

Recovery Support Group Attendance Log

Treatment Provider Report

Approval Forms

Evaluator Approval Request

Therapist Approval Request