Forms and Applications
We want to to provide easy access to the forms and applications you need. On this page, you can find information and sample application forms for nurses, medication aides, dialysis technicians, community health workers and more.
All licensure and certification applications must be completed online. Please go to the home page and click the button “Licensing-Apply/Renew Online" to access the online applications. The “sample” applications on this website are for reference only and are provided for informational purposes.

Criminal Records Checks
Go to the Licensing, Certification & CE section located at the top of the website and on that page, see the information for Criminal Records Checks.
Check the Status of Your License Application
To check the status of a license application, log onto your dashboard, click “options” and then “review status.” If you need assistance accessing your Dashboard, please contact the Ohio eLicense Customer Service Help Desk at 614-466-3947 Option 1 Monday-Friday, 8am-5pm.
Application Fees Must be Paid Online Using a Credit or Debit Card
Application fees must be paid online using a Master Card, VISA or Discover credit or debit card. If you do not have this type of personal credit or debit card, you can obtain these pre-paid cards at local stores.
If the fee is not paid when you submit your application online, the application will be incomplete and will not be processed until you submit all required fees. All fees are non-refundable.
If you purchase a prepaid Master Card, VISA or Discover credit or debit card, please have enough funds on it to cover (a) the credit/debit card company’s processing fee, if applicable; (b) the Board’s application fee; and (c) the state’s transaction fee of $3.50.
RN and LPN Licensure by Examination Application
Please go to the front page of the website and click the button “Licensing-Apply/Renew Online” to access the online applications. The sample applications are for reference only and provided for informational purposes.
RN and LPN Licensure by Endorsement (Reciprocity) Application
For information about verification of your out-of-state license, go to the Licensing, Certification & CE section at the top of the website, click on “RN, LPN, and APRN,” and scroll to Out-of-State Nurse Applicants.” To apply, go to the home page and click the button “Licensing-Apply/Renew Online” to access the online applications. The sample applications are for reference only and provided for informational purposes.
LPN IV Therapy Form
LPNs who are licensed in Ohio to administer medications and want to become licensed to provide IV therapy must complete an approved Intravenous Therapy CE Course.
Advanced Practice Registered Nurse Applications: Initial Licensure; Renewal; Reinstatement/Reactivation
- Certified Nurse Midwife Renewal Application
- Certified Registered Nurse Anesthetist Renewal Application
- Certified Nurse Practitioner Renewal Application
- Clinical Nurse Specialist Renewal Application
- Advanced Practice Registered Nurse Application Certified Nurse Midwife
- Advanced Practice Registered Nurse Application Clinical Nurse Specialist
- Advanced Practice Registered Nurse Application Certified Nurse Practitioner
- Advanced Practice Registered Nurse Application Certified Registered Nurse Anesthetist
- Advanced Practice Registered Nurse License Reactivation and Reinstatement Application
- Approval Form for Organizations Issuing National Certification for Advanced Practice Registered Nurses
RN and LPN License Renewal, Reinstatement/Reactivation Applications
Nursing Education Program Related Forms
- Nursing Education Dissatisfaction Form
- The Preceptor Qualification Form
- Conditional Approval Progress Report Form
Program Completion Letter Guidelines
- Program Completion Letter Guidelines
- Abbreviated Name for PCL ZIP Files
- Certification of Registered Nurse (RN) Education Program Completion
- Certification of Practical Nurse (PN) Education Program Completion
- Certification of Military CCAF Practical Nurse (PN) Education Program Completion
The Board of Nursing accepts completion program letters by email. Find guidance documents and samples below. If you have any questions, please email education@nursing.ohio.gov.
New Program Proposal Forms
- Nursing Education New Program Approval Process
- Practical Nursing New Education Program Proposal Instructions
- PN New Program Proposal Application
- Location of Curriculum Content for Practical Nursing Education Programs
- Nursing Education New Program Approval Process
- Registered Nursing New Education Program Proposal Instructions
- New Education Program Proposal Application
- Location of Curriculum Content for Registered Nursing Education Programs
Education Program Pre-Survey Visit Forms
- Location of Curriculum Content for Form C Registered Nursing Education Programs
- The Survey Visit Process
- Education Program Presurvey Visit Report Instructions
- Pre-survey Visit Report (PVR) PN Programs
- Education Program PN Presurvey Visit Report Form
- PN Verification of Rule Compliance
- Location of Curriculum Content for Practical Nursing Education Programs
- Education Program Presurvey Visit Report Instructions
- Pre-Survey Visit Report (PVR) RN Program
- Education Program RN Presurvey Visit Report Form
- Verification of Rule Compliance
Education Program Annual Report Form
Continuing Education Related Forms
Nursing Education Grant Program (NEGP Forms)
Community Health Worker Certification Applications and Training Program Application Forms
Please go to the front page of the website and click the button “Licensing-Apply/Renew Online” to access the online applications. The sample applications are for reference only and provided for informational purposes.
- Community Health Worker Application
- Attestation of Community Health Worker Training Program Completion – Form A
- Community Health Worker Renewal Application
- Community Health Worker Reactivation & Reinstatement Application
Program Approval Forms
Dialysis Technician Certification Applications and Training Program Application Forms
Please go to the front page of the website and click the button “Licensing-Apply/Renew Online” to access the online applications. The sample applications are for reference only and provided for informational purposes.
- Dialysis Technician Application Supplemental Forms A, B, C & D
- Dialysis Technician Renewal Application
- Dialysis Technician Reactivation and Reinstatement Application
- Dialysis Technician Intern Application
- Dialysis Technician Application
Program Approval Forms
Medication Aide Certification Applications and Training Program Application Forms
Please go to the front page of the website and click the button “Licensing-Apply/Renew Online” to access the online applications. The sample applications are for reference only and provided for informational purposes.
- Medication Aide Application Form
- Attestation of Medication Aide Training Program Completion – Form A
- Medication Aide Renewal Application
- Medication Aide Reactivation & Reinstatement Application
Program Approval Forms
Volunteer Certificate Forms
Alternative Program for Substance Use Disorder
- Form A1 – Initial Voluntary Temporary License/Certificate Surrender
- Alternative Program Application
- Alternative Program for Substance Use Disorder Frequently Asked Questions
Compliance Post-Disciplinary Monitoring
If you are mailing one of the forms below to the Board of Nursing, please write on your envelope, along with the address, ATTENTION: MONITORING. This will help facilitate processing your request.
- Educational Needs Assessment and Learning Plans
- FirstSource Solutions Enrollment Packet and FAQs
- FirstSource Solutions Enrollment Packet and FAQs – Effective 9/1/2021
- Form 1 – Employer Report
- Form 4 – Meeting Documentation
- Form 5 – Medication Report
- Form 6 – Medical Report
- Form 7 – Prescription Medication Report
- Form 9 – Mental Health Professional Report
- Form 10 – Probation Report
- Form 11 – Release of Information
- Form 12 – Substance Abuse Treatment Program Report (Aftercare)
- Form 13 – Substance Abuse Treatment Program Report
- Form 14 – Treating Healthcare Practitioner List