Results 1 - 10 of 14
... tab and follow the instructions to search by license number or name.
Once you have located the nurse’s information you can print a copy for your records. You could provide this
paper copy in the event of an emergency, natural disaster or to obtain discounts ...
Date:
January
29, 2026
... which means that you held a Minnesota RN license and the Minnesota Board of Nursing had a current copy of your certification as an
APRN.
The undersigned does hereby affirm that the statements contained in this application are true and correct.
_________________________________
_______
Print Name
_________________________________
_______
Legal Signature
_______________________
Date (mm/dd/yyyy)
- OR -
...
Date:
January
20, 2026
... which means that you held a Minnesota RN license and the Minnesota Board of Nursing had a current copy of your certification as an
APRN.
The undersigned does hereby affirm that the statements contained in this application are true and correct.
_________________________________
_______
Print Name
_________________________________
_______
Legal Signature
_______________________
Date (mm/dd/yyyy)
- OR -
...
Date:
January
20, 2026
... Plan
START DATE
(Month/Day/Year)
ATTACH A COPY OF CURRENT LICENSE FROM BORDER STATE.
LEGAL SIGNATURE
DATE
(mm/dd/ ...
Date:
January
20, 2026
... which means that you held a Minnesota RN license and the Minnesota Board of Nursing had a current copy of your
-------
---
certification as an APRN.
___________________________________
________________
Legal Signature
___________________
...
Date:
January
20, 2026
... supply information may result in denial of a license. Falsification or omission of information
may be used by the Board as a basis for disciplinary action.
• Type or print clearly
LAST NAME
MAIDEN NAME
STREET ADDRESS
• Provide ...
Date:
January
20, 2026
... supply information may result in denial of a license. Falsification or omission of information
may be used by the Board as a basis for disciplinary action.
•
Type or print clearly
LAST NAME
MAIDEN NAME
STREET ADDRESS
•
Provide ...
Date:
March
06, 2026
... by
a national nursing or medical organization. A copy of the current nursing specialty certification at the time the licensee
renewed his/her nursing license must be kept to evidence the licensee met ...
Date:
January
27, 2015
... Document damaged or destroyed
Name change.
•
Enclose a copy of legal proof of name change, such as a marriage certificate or court order.
•
Enclose the public health nurse certificate.
Other, explain:
DOCUMENT REQUESTED
LPN License # _____________________. Include $20.00 nonrefundable fee.
RN License # ______________________. Include $ ...
Date:
January
20, 2026
... emailed to the Program Director, which includes a copy of the completed survey. You will also be ... detailed below, including directions and screen prints for each section of the survey. If you ...
Date:
August
13, 2025