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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

DETERMINE ELIGIBILITY:

ENDORSEMENT APPLICATION REQUIREMENTS and INSTRUCTIONS:

Please read the Application Instructions carefully before proceeding with an application.

Note: Virginia participates in the NURSYS license verification system and requires license verification through NURSYS for endorsement licensure applicants. Click here to determine if your original state of Licensure participates in the Nursys verification system. 

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

 

Licensure by Examination – Practical Nurse

DETERMINE ELIGIBILITY:

EXAM APPLICATION REQUIREMENTS and INSTRUCTIONS:

Please read the Application Instructions carefully before proceeding with an application.

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

 

Licensure by Repeat Examination - Practical Nurse

Application and Instructions for Licensure by Repeat Examination as a Practical Nurse

 

Registered Nurse

Licensure by Endorsement – Registered Nurse


DETERMINE ELIGIBILITY:

ENDORSEMENT APPLICATION REQUIREMENTS and INSTRUCTIONS:

Please read the Application Instructions carefully before proceeding with an application

Note: Virginia participates in the NURSYS license verification system and requires license verification through NURSYS for endorsement licensure applicants.  Click here to determine if your original state of Licensure participates in the NURSYS license verification system.

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



 

Licensure by Examination - Registered Nurse

DETERMINE ELIGIBILITY:

EXAM APPLICATION REQUIREMENTS and INSTRUCTIONS:

Please read the Application Instructions carefully before proceeding with an application

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



 

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 for Registered and Practical Nurses (RN/LPN)

 

 

Restricted Volunteer License

 

Clinical Nurse Specialist - Online Application

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


Reinstatement Application for Clinical Nurse Specialist

Application for Reinstatement of Registration as a Clinical Nurse Specialist

 

Nurse Practitioner Application - Online Application

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

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. 

 

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

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

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

 

 

Licensed Massage Therapist Applications

Effective January 1, 2017, all MASSAGE THERAPIST licensure applicants are required to have a fingerprint-based criminal background check (CBC). This requirement applies to applicants by initial licensure, endorsement and reinstatement.  For more information about initiating this process visit the Criminal Background Checks page.

Please click here to read the Laws Governing Nursing. Please click here to read the Regulations Governing the Licensure of Massage Therapists.

Licensure Application by Endorsement – Massage Therapist (online application)

Applications for licensure as a Licensed Massage Therapist by Endorsement are now exclusively accepted online. Please read the application questions carefully before answering each question. Click here to begin the online application process.


Licensure Application by Initial Licensure – Massage Therapist (online application)

Applications for licensure as a Licensed Massage Therapist by Initial Licensure are now exclusively accepted online. Please read the application questions carefully before answering each question. Click here to begin the online application process.



Licensure Application by Reinstatement – Massage Therapist (paper application)

Checklist Instructions and Application for Reinstatement of License as a Massage Therapist

Licensure Application by Reinstatement following Suspension or Revocation – Massage Therapist (paper application)

Checklist Instructions and Application for Reinstatement of License as a Massage Therapist following Suspension or Revocation

 

 

 

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

Click here to begin the online application process for CNA by Endorsement (tested and certified in another state) and Advanced Nurse Aide Certification.

Application for CNA by Examination in Virginia: (NNAAP) Click here to link to VUE’s (Pearson VUE's) website for information and an application to sit for the Virginia Nurse Aide Competency Test ("State Board")

Reinstatement Applications

CNA Reinstatement Application and Instructions

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

Click here to begin the online application process for Registration by Examination and Endorsement for Medication Aides.

Candidate Information Bulletin from PSI (pdf)

Link to PSI's website for examination information

Reinstatement Application

Instructions for Fililng an Application for Reinstatement as a Medication Aide

Application for Reinstatement of Medication Aide Registration

 

 

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

Note: You are not required to file a volunteer practice registration application if you hold a current unrestricted license or a multi-state privilege to practice nursing in Virginia.

 

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 - Instructional Personnel Form

Nurse Aide Education Program Skills Record

Nurse Aide Education Program Curriculum

 

Compliance Forms & Information

Compliance FAQs

Self Report Form

Nursing Self Report Form

Licensed Massage Therapist 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

Licensed Massage Therapist Performance Evaluation

Certified Nurse Aide Performance Evaluation

Registered Medication Aide Performance Evaluation

Licensed Nurse Practitioner - Supervisor's Report Form

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