Forms

Certified Nurse Aide

Initial applications for Certified Nurse Aide by Endorsement are accepted exclusively online through the Virginia Board of Nursing.  Click Here to initiate the application process.

Checklist Instructions for Certification by Endorsement as a Nurse Aide

Initial applications for Certified Nurse Aide by Examination in Virginia are processed through the testing service - Credentia.  Please click here to link to Credentia's website for information and an application to sit for the Virginia Nurse Aide Competency Test ("State Board").

If you are unsure of how to apply, please see our Application Wizard for guidance.

Reinstatement Application

If a nurse aide certificate has lapsed for more than ninety (90) days an application for reinstatement is required. Reinstatements for CNA's are now accepted online. Please login to the Online Licensing site to begin the Reinstatement process.

Checklist Instructions for Certification by Reinstatement as a Nurse Aide

Employment Verification Form - Nurse Aide

Advanced Certified Nurse Aide

Initial applications for Advanced Certified Nurse Aide certification are accepted exclusively online through the Virginia Board of Nursing. Click Here to initiate the application process. 

Checklist Instructions for Advanced Certification as a Nurse Aide

In order to qualify as an advanced certified nurse aide, you must meet the requirements set forth under 18VAC90-25-110 (A):

• Hold current certification as a certified nurse aide in Virginia;
• Have been certified for at least three years as a certified nurse aide;
• Have never had a finding of abuse, neglect or misappropriation of patient property entered on a nurse aide registry in any jurisdiction and have not had any disciplinary actions taken by the board within the five years preceding application for advanced certification;
• Have a recommendation for advanced certification from a licensed nurse who has supervised the applicant in providing direct patient care for at least six months within the past year; and
• Have successfully completed a minimum of 120 hours of advanced training in an approved program that includes a competency evaluation acceptable to the board.

Advanced Reinstatement Application

Advanced CNA Reinstatement Application and Instructions

For more information on Compliance, please visit our FAQ page, and select the topic named "Compliance with a Nursing Board Order"

Self Report Forms

Self Report Form

Performance Evaluation Form

Performance Evaluation

Miscellaneous Forms

Drug Log For Prescribers (.xls)

Notification of Board Order

Initial Contact Form

Prescriber Report

Recovery Group Attendance Log

Treatment Provider Report

Approval Forms

Evaluator Approval Request

Therapist Approval Request

Employment Approval Request

Please use our Application Wizard for guidance on how to apply for initial licensure as a Practical Nurse.

Applications for initial licensure as a Practical Nurse by Endorsement or Examination are accepted exclusively through our online system.

Licensure by Endorsement

Endorsement Application Instructions

Licensure by Examination

Examination Application Instructions

Licensure by Repeat Examination

 RN-LPN Repeat Exam Application

Reinstatement

Reinstatements (Lapsed or Expired) for Practical Nurses are now accepted online. Please login to the Online Licensing site to begin the Reinstatement process.

Reinstatement (Lapsed or Expired) Application Instructions

RN-LPN Reinstatement After Discipline Application (Suspension or Revocation)

Reactivation

Inactive to Active Request Form (RN and LPN)

Nurse Licensure Compact

Declaration of Primary State of Residence Form

Please use our Application Wizard for guidance on how to apply for initial licensure as a Registered Nurse.

Applications for initial licensure as a Registered Nurse by Endorsement or Examination are accepted exclusively through our online system.

Licensure by Endorsement

Endorsement Application Instructions

Licensure by Examination

Examination Application Instructions

Licensure by Repeat Examination

RN-LPN Repeat Exam Application

Reinstatement

Reinstatements (Lapsed or Expired) for Registered Nurses are now accepted online. Please login to the Online Licensing site to begin the Reinstatement process.

Reinstatement (Lapsed or Expired) Application Instructions

RN-LPN Reinstatement After Discipline Application (Suspension or Revocation)

Reactivation

Inactive to Active Request Form (RN and LPN)

Nurse Licensure Compact

Declaration of Primary State of Residence Form

Please use our Application Wizard for guidance on how to apply for initial licensure as a Advanced Practice Registered Nurse.

Applications for initial licensure as an Advanced Practice Registered Nurse are accepted exclusively online.

NOTE:  If you already have an Advanced Practice Registered Nurse 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 an Advanced Practice Registered Nurse  mailed to you.  You cannot use the online advanced practice registered nurse application process to apply for additional specialties.

Application Instructions for Licensure - Advanced Practice Registered Nurse

Autonomous Practice

Autonomous Practice Application - Effective July 1, 2024, Advanced Practice Registered Nurses (except Certified Registered Nurse Anesthetists, Certified Nurse Midwives, Clinical Nurse Specialists) with an equivalent of 3 years of full-time clinical experience may apply for full practice authority (autonomous practice).

Reinstatement Forms

APRN license or RX Authority Reinstatement Application (Lapsed or Expired)

APRN License or RX Authority Reinstatement Application (Suspension or Revocation)

The Committee of the Joint Boards of Nursing and Medicine promulgated regulation changes that resulted in the elimination of the requirement for advanced practice registered nurse practitioners to obtain/maintain a separate prescriptive (Rx) authority license (#0017). Read more here.

NOTE:  If you already have an Advanced Practice Registered Nurse Practitioner (APRN) license and you wish to add Authorization to Prescribe (Prescriptive Authority), you will need to contact the Board of Nursing at (804) 367-4515 to have a paper Application for Licensure as an Advanced Practice Registered Nurse Practitioner mailed to you.  You cannot use the online APRN application process to apply for additional specialties.

Please use our Application Wizard for guidance on how to apply for a license as a Massage Therapist

Applications for licensure as a Massage Therapist are accepted exclusively through our online system.

Endorsement
Checklist Instructions for Licensure by Endorsement as a Massage Therapist
Verification Form - Massage Therapist (form required for applicants applying to Virginia who have been licensed/certified/ registered as a massage therapist in another state/jurisdiction)

Initial Licensure
Checklist Instructions for Initial Licensure as a Massage Therapist

Reinstatement
Checklist Instructions and Application for Reinstatement as a Massage Therapist

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

Applications for initial registration as a Medication Aide by Examination or Endorsement are accepted exclusively through our online system.

Examination

Checklist Instructions for Registration by Examination as a Medication Aide

Candidate Information Bulletin from PSI

Endorsement

Checklist Instructions for Registration by Endorsement as a Medication Aide

Please use our Application Wizard to help determine how to apply for initial registration as a Medication Aide

Reinstatement Application Forms

Application and Instructions for Reinstatement of Medication Aide Registration

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.

Instructions and Application for Registration for Volunteer Nursing Practice

Volunteer Practice Sponsor Form

Click here to view applicable nursing regulation 18 VAC 90-19-200

Instructions and Application for Restricted Volunteer Nursing License

Click here to view § 54.1-3011.01. Restricted volunteer license for registered or practical nurses

Click here to view § 54.1-2957.001. Restricted volunteer license for nurse practitioners

Request Form for Change of Status from Inactive to Active (Registered or Practical Nurses)

This is a PDF form that will need to be printed, filled out and sent to:

Virginia Board of Nursing
Perimeter Center
 9960 Mayland Drive, Suite 300
 Henrico, Virginia 23233-1463

Name Change Information

All licensees/applicants wishing to change their name with the Board must submit their request using the Nursing Name Change Form. Follow the instructions on the form when the required information is submitted.

Pursuant to 18 VAC 90-19-50 (B) a copy of one of the following documents must accompany a name change request:
 • Marriage Certificate
 • Certificate of Naturalization
 • Court Order

Out-of-State Practitioner Reporting Form

Virginia Code § 54.1-2408.4 permits health care practitioners licensed, certified, or registered in another state or the District of Columbia to temporarily practice in the Commonwealth for 90 days provided certain provisions are met. These individuals may only practice temporarily for 90 days after receiving an offer of employment or contract for services from: (1) a hospital licensed by the Virginia Department of Health, (2) a nursing home, (3) an assisted living facility, (4) a dialysis facility, (5) the Virginia Department of Health, or (6) a local health department.

Eligible employers and contract service recipients must fill out this form and submit it to the Board before the practitioner begins temporarily practicing in Virginia.