Board of Nursing Forms and Other Documents

Forms and Publications for the NH OPLC Board of Nursing

New Hampshire has a mandatory licensing law. No person may practice as a nurse or nursing assistant without a license. The Board of Nursing defines "practicing" as including attendance at orientation or completing other types of non-director care activities.
All completed, signed forms are legal documents and must be reproduced as they appear.
Most license applications may be completed using the online licensing system as opposed to the "paper forms" below.

Please use quality paper for printing the applications (white 8 1/2 x 11 inch paper must be used).
Be sure that the form prints completely, making sure that all text is legible, and all boxed content, seals and symbols are displayed.
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.
Be sure to sign and date the and include the correct application fee.

Initial program approval documents: Contact Board of Nursing office 603 271 2152 and ask to speak with the LPN/RN Clinical Program Specialist
Educator Faculty Approval
Site Visit Rules Crosswalk
Annual Report Forms – Contact Board of Nursing office 603 271 2152 and ask to speak with the LPN/RN Clinical Program Specialist.
Educational Complaint Reporting
Pre-Licensure Out of State/Distance Education - Required pursuant to Nur 602.15 (j)
Online Distance Education or Post-Licensure Education
- School Approval Needed Chart

Clinical Practice Inquiry
Declaration Primary State of Residency
Nurse Audit
Physician and Counselor Report
Work Performance Report
LPN Comparable Education Verification Form
RN Comparable Education Verification Form
Request for NCLEX Accommodations under the Americans with Disabilities Act
Registered Nurse / Licensed Practical Nurse Licensure Applications
There is not a process for on-line submissions of License by Examination (NCLEX) applications at this time.
The state criminal background check (How to Obtain a Criminal Background Check) is required for all nursing license by examination applicants. Licensees receiving conditional licenses because of inability to obtain fingerprints/FBI background check will receive instructions regarding completion of the FBI criminal background check with fingerprinting after the conditional license is granted.
The Board office is unable to 'hold' applications or money/checks in the event an incorrect form or fee was submitted.
An applicant's signature on the single state criminal background check form (DSSP 256 Criminal History Record Information Release Authorization) may be notarized without being in the presence of the notary - please refer to the Governor's Emergency Order #11: Temporary authority to perform secure remote online notarization. The applicant will send the signed, notarized form to the Board of Nursing Office with the appropriate fee where we will process the payment and forward it on to the state police.