Forms

Effective 11/1/07, New Requirements for Verification of Citizenship or Qualified Alien Status affect application submissions

• Additional Documentation Cover Sheet
• Advanced Practice Licensure
• Affidavit of Citizenship Status
  
• AUA Certification Application Instructions
• AUA Application for Rewrite Instructions
• Certificate for Framing
• Certificate of Incorporation
  
• Change of Address with Declaration of Primary State of Residence
  
• Closed School Transcript Request
• Employment Verification Form
• Endorsement - Single State License

  • Instructions for completion of the Endorsement Application for U.S. Educated Nurses
    
  • Instructions for completion of the Endorsement Application for Nurses Educated Outside the U.S.
  • NURSYS Website Link:
    http://www.nursys.com
    
• Evidence of Status
• Inactive Status Application
• Initial Determination of Eligibility for Licensure or Certification
• Information for Applicants with History of Arrest or Disciplinary Action
• Instruction and Form for Requesting Reasonable Accommodations for NCLEX
  
• Investigation/Discipline Forms

  • Nurse's Initial Medication Report
  • Nurse's Seventy-Two Hour Medication Report
  • Prescriber Medication Report
  • Report of Nursing Practice Incident
  • Report of Supervised Practice
  • Self Assessment Report
  • Support Group Attendance Form
    
• Multistate Licensure Instructions (Available 1/5/18)

  • Multistate Licensure by Endorsement for U.S. Educated Nurses
  • Multistate Licensure by Endorsement for Nurses Educated Outside the U.S.
    
  • Multistate Licensure by Examination
  • Multistate Licensure by Examination - Rewrite
  • Multistate Licensure for Existing Active Oklahoma Licensees
  • Multistate Licensure for Existing Not Active Oklahoma Licensees
    
• Name Change Request
• NCLEX - Single State License

  • Instructions for completion of the Licensure by Examination (RN and LPN) Application
  • Instructions for completion of the Rewrite Application
  • Instructions and Learning Packet for Practical Nurse Equivalency Candidates
  • Instructions for NCLEX or AUA Certification Candidates with History of Arrests/Convictions/Prior Disciplinary Actions
• Oklahoma Nursing Practice Act & Rules
• Peer Assistance Program Forms

  • Counselor Report Form
  • Nurse Support Group Facilitator Report Form
  • Sponsor Report Form
  • Supervised Practice Report Form
  • Support Group Attendance Form
• Prescriptive Authority (CNP, CNM, CNS)

  • Agreement for Physician Supervising Advanced Practice Prescriptive Authority
  • Change in Supervising Physician(s) for Advanced Practice Prescriptive Authority: Application and Instructions
  • Exclusionary Formulary
  • Prescriptive Authority CNP, CNM, CNS Instructions
  • Prescriptive Authority Continuing Education Tracking Form
    
  • Request for Review of Pharmacology Contact Hours)
• Prescriptive Authority (CRNA)

  • Inclusionary Formulary
  • CRNA Authority to Select, Order, Obtain and Administer Drugs Instructions
  • Prescriptive Authority Continuing Education Tracking Form
  • Request for Review of Pharmacology Contact Hours
• Reinstatement or Return to Active Status of License/ Certificate/Recognition - Single State

  • Advanced Practice Registered Nurse Licensure
  • AUA Certification
  • CRNA Authority to Select, Order, Obtain and Administer Drugs
  • Prescriptive Authority for CNP, CNM, CNS
  • RN/LPN Licensure
• Request for Nursing Students to Attend Board Meeting
• Request for Social Security Number Change/Correction
• Volunteer License Application and Instructions
• Written Verification of Licensure

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Oklahoma Board of Nursing
2915 N Classen, Ste. 524
OKC, OK   73106
TEL: 405.962.1800 FAX: 405.962.1821

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OBN Webmaster at: obnwebmaster@nursing.ok.gov

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