Forms & Publications

New Hampshire RN Licensure Renewal Data Elements Survey - The survey can be completed at anytime during a license renewal period. This data is important for a better understanding of the nursing workforce in NH

Important Information for all Licensees NH has a mandatory licensing law. No person may practice as a nurse or nursing assistant without a license. The NH Board of Nursing defines "practicing" as including attendance at orientation or completing other types of non-director care activities. Criminal record authorization forms are available on line . You must contact the Board office for the FBI fingerprint cards. For more information or any questions, please see the Board's home page. All completed, signed forms are legal documents and must be reproduced as they appear. Incomplete or poorly printed forms will be returned. Most license applications may be completed using the on-line licensing system as opposed to the "paper forms" below. Go to the on-line licensing link. FBI fingerprint and the criminal record release authorization forms must be filed with the NH Division of State Police, and received and reviewed by the Board of Nursing before a license can be issued. See paragraph above for obtaining these forms and fingerprint cards.

 

General Instructions for Forms

• Please use quality paper for printing the applications (white 8 1/2 x 11 inch paper must be used).
• Be sure that the prints completely, making sure that all text is legible, and all boxed content, seals and symbols are displayed.
• Read and follow the application directions.
• Respond to all questions and fill in all requested information.
• Note: If the answer is none or N/A, please state so. Applications not completely filled out will be returned to you as incomplete.
• Submit the completed application to the New Hampshire Board of Nursing.
• Be sure to sign and date the and include the correct application fee.

Advanced Practice Registered Nurse Licensure Applications	Nursing Assistant Education Program
Clinical Practice	Other Forms
LNA/MNA Education Program Report and Site Visits	Registered Nurse
Licensed Nursing Assistant Licensure Applications	Registered Nurse and Practical Nurse Programs
Licensed Practical Nurse	Registered Nurse Licensure
Nurse Education	Registered Nurse: Canadian Educated Licensure Applications
Publications

 

All documents have been saved in Adobe Acrobat Reader format.

Advanced Practice Registered Nurse

• Application for Initial Licensure
• Application Temporary Licensure: Newly Graduated Only

Clinical Practice

• Inquiry Form  

Licensed Nursing Assistant Licensure Applications

• Application for License by Endorsement
• Initial LNA License Application by Competency Evaluation and Comparable Education
• LNA Audit
• Medication Nursing Assistant Certification Application

Licensed Practical Nurse

• Application for License by Endorsement
• Application for License by Exam

Nursing Assistant Education Program

• Challenge Program Self-Assessment
• LNA Competency Testing Accommodation Request
• LNA Education Request for On-Site Visit
• LNA Education Self Assessment
• MNA Education Request for On-Site Visit
• Nursing Assistant Reimbursement
• Train The Trainer Self Assessment

Nurse Education

• Annual Program Report
• Educator Faculty Approval
• Faculty Prerequisites
• Interim Education Report
• LPN IV Program Review

Other Forms

• Change of Name/Address
• Clinical Practice Inquiry  
• Complaint
  • Complaint, how to complete
• Criminal Background Check
• Declaration of Primary State of Residence (RN, LPN, APRN only)
• Educational Complaint Reporting
• Interim Education Report
• Nurse Audit
• Nursys Verification
• Request for Accommodations under the Americans for Disability Act
• Road to Recovery
  • Employer Report
  • Monthly Self Reporting
  • Point System
  • Quarterly Progress Report of Therapy
  • Support Group/Group Therapy Report

Registered Nurse

• Application for License by Endorsement
• Application for License by Exam

Registered Nurse and Practical Nurse Programs

• Nursing Program Site/Visit Review Form

Registered Nurse: Canadian Educated Licensure Applications

• Application for Canadian Educated Nurse: Endorsement of Canadian License

Publications

• New Hampshire Board of Nursing Newsletter
  If you would like older copies of the Newsletter, please email the Board

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