Forms

Renewal of Kansas nursing license

• License Renewal Application

Reinstatement of previous Kansas license

• Reinstatement Application (All Professions)
• Affidavit of Work Hours

Endorsement from another state

• Endorsement Application (All Professions)
• Legal Issues Reference Packet
• Affidavit of Work Hours
• Request Nursys Verification Request

Advanced Practice

• Advanced Practice Application
• Nurse-Midwife Affidavit

Examinations and Foreign Applications

• Initial License
• Waiver Agreement and Statement Fingerprint-Based Record Checks for Noncriminal Justice Purposes
• Legal Issues Reference Packet
• Test Before Transcript
• Petition for Examination Test or Retest
• Instructions for Foreign Nurses

Miscellaneous Licensing

• Address Change
• Change of Name Certificate
• Duplicate License Affidavit
• IV Therapy Application
• APRN State to State Verification
• Additional Wall Certificate Order Form for any License

• Individual Offering Approval (IOA)
• Long-Term Provider Application and Guidelines
• Single Program Application and Guidelines
• IV Therapy Provider Application
• Long Term Provider Annual Report Form
• IV Therapy Roster
• IV Therapy Competency Checklist
• IV Therapy Annual Report Form

• Controlled Substance Verification

• Information Request Form

• How to File a Complaint

• Don’t see the form you want? Submit a request!