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Applications and Forms

Listed below, by subject-matter category, are the forms available on this site.

About Us

DOCUMENT TITLE DESCRIPTION
Strategic Plan Report
Customer Service Evaluation Form Form

Applicants

DOCUMENT TITLE DESCRIPTION
Application for Licensure by Examination Application
Application to Repeat/Reapply for Examination Application
Application for Licensure by Endorsement Application
Minimum Requirements for a Temporary License to be Issued at the Board Office Information
Verification of License Online Endorsement Form
Request for Transcript Online Endorsement Form
Supplemental Instructions and Forms for Applicants Educated Outside the US Online Endorsement Form
Endorsement Applicant Identification Online Endorsement Form
8-Year Retake Application Application
Request for Live Scan Service Form (Exam and Endorsement Applicants Only) Form
Accommodation of Disability Form
Application for Clinical Nurse Specialist Certification Application
Application for Nurse Anesthetist Certification Application
Application for Nurse-Midwife Certification Application
Nurse-Midwife Furnishing Number Application Application
Application for Nurse Practitioner Certification Application
Nurse Practitioner Furnishing Number Application Application
Application for the Listing as a Psychiatric/Mental Health Nurse Application
Application for California Public Health Nurse Certificate Application
Instructions for Providers Information
Title 16, Division 14, Article 5 California Code of Regulations Regulation
Application for Approval as a Continuing Education Provider Application
Change of Address and/or Name for Applicants Form

Schools

DOCUMENT TITLE DESCRIPTION
RN Programs Listing
Clinical Nurse Specialist Programs Listing
Nurse Anesthesia Programs Listing
Nurse-Midwifery Programs Listing
Public Health Nursing Program Listing
Instructions for Institutions Seeking Approval of New Prelicensure Registered Nurse Program Guidelines
Background Checks for Student Clinical Placement Practice Information - RN
Clinical Learning Experiences - Nursing Students Practice Information - RN
Community College: Associate Degree Nursing Programs - Merit-Based Admission Policy - An act to add and repeal Section 78261.5 of the Education Code Practice Information - RN
Nursing Education Practice Information - RN
Joint-Appointment Faculty Statement Report
NCLEX Review Resources Listing
Refresher Courses Listing

Licensees

DOCUMENT TITLE DESCRIPTION
Renewal Form (Timely)Form
Renewal Form (Delinquent)Form
Continuing Education Certification Form
Fingerprint Certification Form
Request for Live Scan Service Form
License Discipline / Conviction Certification Form
Inactive to Active License Form
Application for Reinstatement of a Lapsed License (8-Year Renewal)Form
Request for Duplicate LicenseForm
Change of Address and/or Name for LicenseesForm
Special Renewal Provisions for Military RNsForm

Enforcement

DOCUMENT TITLE DESCRIPTION
Complaint Form Form
Disciplinary Guidelines - Including Policy on Denial of Licensure Information
Expert Witness Application Application
Insurance Settlement FormForm

Probation

DOCUMENT TITLE DESCRIPTION
Quarterly Report Form

Diversion

DOCUMENT TITLE DESCRIPTION
Role Delineation Diversion Evaluation CommitteeInformation
Diversion Evaluation Committee ApplicationApplication
Role Delineation for Nurse Support GroupsInformation
Nurse Support Group Facilitator/Co-Facilitator Procedural RequirementsInformation
Criteria for Approval of Nurse Support Group Facilitator/Co-FacilitatorsInformation
Listing of Nurse Support GroupsInformation
Application for Nurse Support Group Facilitator/Co-FacilitatorsApplication

Regulations

DOCUMENT TITLE DESCRIPTION
Abandonment of PatientsPractice Information - RN
Abuse Reporting RequirementsPractice Information - RN
An Explanation of the Scope of RN Practice Including Standardized Procedures Practice Information - RN
RNs' Professional Role is Established by Law (Nursing Practice Act, Scope of Practice, Section 2725) Practice Information - RN
Authorization for RNs to Dispense Drugs and Devices on the Order of an NP, CNM, and PA in a Licensed Primary Care Clinic Practice Information - RN
Background Checks for Student Clinical PlacementPractice Information - RN
California Nursing Practice Act Practice Information - RN
California State Board of Education Response to Frequently Asked Questions on Medication Administration Assistance in SchoolsPractice Information - RN
Children in School with Specialized Physical Health Care ServicesPractice Information - RN
Clinical Learning Experiences Nursing Students Practice Information - RN
Community College: Associate Degree Nursing Programs - Merit-Based Admission Policy - An act to add and repeal Section 78261.5 of the Education CodePractice Information - RN
Complaint Disclosure PolicyPractice Information - RN
Complementary and Alternative Therapies in Registered Nursing PracticePractice Information - RN
Conscious SedationPractice Information - RN
Continuing Education for License Renewal Practice Information - RN
Department of Health Services: Reporting and Inspection RequirementsPractice Information - RN
Dual LicensurePractice Information - RN
Emergency Medical Services: Immunity for RN Practice Information - RN
Good SamaritanPractice Information - RN
Information About Medical Assistant Practice Information - RN
Insulin Administration in Public Schools Practice Information - RN
Interim PermitteePractice Information - RN
Intermediate Care Facilities for the Developmentally DisabledPractice Information - RN
License InformationPractice Information - RN
Licensed Vocational Nurse Regulations Governing Intravenous Therapy (This information is from the Board of Vocational Nursing and Psychiatric Technicians and will redirect to their website.) Practice Information - RN
Medical Practice Act: Business and Professions Code Section 2023 Study and Evaluation: Use of Laser or Intense Light Pulse Devices Practice Information - RN
Military Spouses - Expedited Licensure Practice Information - RN
Newborn Hearing Screening Testing in General Acute Care HospitalPractice Information - RN
Nurse to Patient Staffing Ratios (This information is from the California Department of Public Health and will redirect to their website.) Practice Information - RN
Nursing EducationPractice Information - RN
Position Statement Regarding Violence Against Health Care Workers and PatientsPractice Information - RN
Preparation Required for Licensed Vocational Nurses Practice Information - RN
Public Health Confidential Medical Information Practice Information - RN
Reproductive Privacy Act Practice Information - RN
Residential Care for the Elderly Employee Training for Self-Administration of MedicationPractice Information - RN
RN Notification of Medical Laboratory Testing Ordered by a Registered Dietician to Afford the RN an Opportunity to Assess the PatientPractice Information - RN
RN Responsibility When Floating to New Patient Care Unit or Assigned to New Population Practice Information - RN
RN Tele-Nursing and Telephone TriagePractice Information - RN
Scrub Nurse Functions by Non-RNs Practice Information - RN
Section 49423.5 of the Education Code Amended Relating to Pupil Health Practice Information - RN
Speech-Language Pathologist and Audiologist Perform Flexible Endoscopic Procedure Practice Information - RN
Standardized Procedure Guidelines Practice Information - RN
Standards of Competent Performance Practice Information - RN
Statement on Delivery of Health Care Practice Information - RN
Nursing Student Workers Practice Information - RN
Supervisor's Responsibility Practice Information - RN
The Bottom Line: The Business of Medicine - Medical Spas (This document was published by the Medical Board of California and will redirect to their website.) Practice Information - RN
Elective Cosmetic Medical Procedures or Treatments: Med Spa Practice Information - RN
Regulations: Physician Availability: Elective Cosmetic Procedures Practice Information - RN
The Registered Nurse as Patient Advocate Practice Information - RN
The Registered Nurse as Supervisor Practice Information - RN
The RN as First Assistant to the Surgeon Practice Information - RN
Tribal Health Programs: Healthcare Practitioners Practice Information - RN
Understanding the Role of the Registered Nurse and Interim Permittee Practice Information - RN
Unlicensed Assistive PersonnelPractice Information - RN
Use of Title: Registered Nurse and Name Tags Practice Information - RN
Waiver of Active Duty Military/Reservist Licensee Renewal Fees and CEUs Practice Information - RN
BRN Certified Clinical Nurse Specialist in the Specialty Psychiatric Mental Health Nursing, and BRN Listed Psychiatric Mental Health RN Practice Information - CNS
Certification of Clinical Nurse Specialist Practice Information - CNS
Nurse Practitioners and Clinical Nurse Specialists in Long-Term Care Settings Practice Information - CNS
Standardized Procedure Guidelines Practice Information - CNS
Nurse Anesthetist (B&P Code) Practice Information - NA
Advanced Pharmacology Continuing Education Course for Furnishing Practice Information - NMW
An Explanation of Standardized Procedure Requirements for Certified Nurse-Midwife Practice Practice Information - NMW
Clinics Eligible for Licensure Practice Information - NMW
Criteria for Furnishing Number Utilization by Certified Nurse-Midwives Practice Information - NMW
General Information: Nurse-Midwife Practice Practice Information - NMW
Health Workforce Projects Practice Information - NMW
Midwifery Practice under Standardized Procedures Prohibited Practice Information - NMW
National Provider Identifiers: Nurse Practitioner and Nurse Midwives Practice Information - NMW
NP and CNM: Change in Requirement for Physician and Surgeon Supervision for Furnishing Practice Information - NMW
Nurse-Midwives: Laws and Regulations Practice Information - NMW
Nurse-Midwives and Nurse Practitioners may Furnish Drugs and Devices in their Solo Practice and Department of Health Services to Consult with BRN when Developing Regulations that Affect the Scope of Practice of a Certified Nurse-Midwife or Nurse Practitioner Practice Information - NMW
Nurse-Midwives Furnishing Controlled Substances Practice Information - NMW
Nurse Practitioners and Nurse-Midwives Supervision of Medical Assistants Practice Information - NMW
Reproductive Privacy Act Practice Information - NMW
Standardized Procedure for Certified Nurse-Midwives for Furnishing Medications Practice Information - NMW
Standardized Procedure Guidelines Practice Information - NMW
Advanced Pharmacology Continuing Education Course for Furnishing Practice Information - NP
Advanced Practice Registered Nurse - Section 12517.2 Vehicle Code Amended - Schoolbus Driver: Medical Examination Practice Information - NP
California Department of Justice Informational Bulletin - Law Changes Directly Impacting the Prescribing and Dispensing of Schedule II and III Controlled Substances Within California Practice Information - NP
California State Board of Pharmacy Rules & Regulations for Nurse Practitioners Practice Information - NP
Clinics Eligible for Licensure Practice Information - NP
Criteria for Furnishing Number Utilization by Nurse Practitioners Practice Information - NP
Elective Cosmetic Medical Procedures or Treatments: Med Spa Practice Information - NP
Regulations: Physician Availability: Elective Cosmetic Procedures Practice Information - NP
Explanation of RN Scope of Practice and Nurse Practitioner Practice Practice Information - NP
Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice Practice Information - NP
Frequently Asked Questions Regarding Nurse Practitioner Practice Practice Information - NP
General Information for Nurse Practitioners Regarding National Certification Practice Information - NP
General Information: Nurse Practitioner Practice Practice Information - NP
Health Workforce Projects Practice Information - NP
Medi-Cal Billing Certified Nurse Practitioner Nationally Certified in a Specialty Practice Information - NP
National Provider Identifiers: Nurse Practitioner and Nurse Midwives Practice Information - NP
NP and CNM: Change in Requirement for Physician and Surgeon Supervision for Furnishing Practice Information - NP
Nurse-Midwives and Nurse Practitioners may Furnish Drugs and Devices in their Solo Practice and Department of Health Services to Consult with BRN when Developing Regulations that Affect the Scope of Practice of a Certified Nurse-Midwife or Nurse Practitioner Practice Information - NP
Nurse Practitioner Expanded Furnishing Authority for Schedule II Controlled Substances, BPC 2836.1 Practice Information - NP
Nurse Practitioner Schedule II Controlled Substance - Education Requirement prior to applying to the DEA for Schedule II Authority Practice Information - NP
Nurse Practitioners: Laws and Regulations Practice Information - NP
Nurse Practitioners in Long-Term Care Settings Practice Information - NP
Nurse Practitioners New Authority to Provide Medications Practice Information - NP
Nurse Practitioners and Nurse-Midwives Supervision of Medical Assistants Practice Information - NP
Reproductive Privacy Act Practice Information - NP
Restraint and Seclusion Orders by Nurse Practitioners Practice Information - NP
Standardized Procedure Guidelines Practice Information - NP
BRN Certified Clinical Nurse Specialist in the Specialty Psychiatric Mental Health Nursing, and BRN Listed Psychiatric Mental Health RNPractice Information - PMH
Psychiatric-Mental Health Nurse - Payments and ProceedsPractice Information - PMH