785-296-4929

INDIVIDUAL OFFERING APPROVAL FORM (IOA)

CONTINUING NURSING EDUCATION FROM COLLEGE CREDITS



This form must be completed in full and approval received BEFORE renewing your license.
Please only submit ONE course per this IOA Form. Do not submit multiple courses on this form. Please Note: 1 college hour = 15 CNE contact hours. Please make sure the course information attached matches the course on this form.

Name

 
KS Nursing License #

 
Expiration Date (mm/dd/yyyy)

 
Street Address

 
City

 
State

 
Zip Code

 
Telephone #

 
Email Address

 
Course Title

 
Course Credit Hours Earned

 
Course Completion Date

 
College/University

 
College/University Address

 

A brief explanation, in your own words, of why this offering is relevant Continuing Nursing Education for you.
**Continuing Nursing Education is defined as “learning experiences intended to build upon the educational and experiential bases of the nurse for enhancement of practice, education, administration and research or theory development to the end of improving the health of the public.”**

This information may be found in your course syllabus.
Example: Students will be able to identify the risk factors for coronary artery disease.

TRANSCRIPT: An OFFICIAL transcript from your University is required and must be submitted electronically. You will upload the official transcript “HERE”.

Attestation
I realize that this application is a legal document and by pressing the Submit button I am declaring under penalty of perjury under the laws of the State of Kansas that the information I have provided is true and correct to the best of my knowledge.
If all the above information is correct please press the Submit button .
Otherwise please go back and correct any information that is necessary.

SUBMIT WILL CONTINUE YOU ON TO THE FILE UPLOAD PAGE