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NURSING

Nevada State Board of

Instructions for Completion and Submission of Fingerprint Card


If you download an application from the Boards website, a fingerprint card will be mailed to you upon receipt
of your application in the Board office. If you request an application by mail, a fingerprint card will be
included in that packet. You may choose to submit the fingerprint card at the same time as your application
but it isnt necessary to do so.
1. All applicants must complete a fingerprint card (Form FD-258) provided by the Nevada State Board of Nursing (the
Board);
OR
If you fingerprint in Nevada, you may choose to have your fingerprints submitted via electronic transmission
(livescan) instead of submitting a card. Electronic transmission is only available if you have your fingerprints
captured in Nevada.
2. Complete the information block on the card, and make sure it is legible: last, first, and middle names; signature;
residence (complete address); citizenship; date of birth; place of birth; sex; race; height; weight; eyes; hair; and
Social Security number (if you have one). Cards without these information blocks completed are considered
incomplete and will be returned to the applicant. Illegible cards cannot be processed.
3. Fingerprinting on the Boards coded card may be done by a law enforcement agency in any state or by a private
fingerprinting service. (The Boards website www.nevadanursingboard.org has a list of Nevada fingerprinting
locations that offer electronic submission as well as fingerprinting on cards.) The Board provides fingerprint capture
by appointment in its offices.
4. Complete and detach the form on the reverse side, and send the fee and completed fingerprint card to the address
below. If you have your fingerprints submitted by electronic submission, you will make payment to the agency that
captures your fingerprints, but you must send a copy of your receipt to the Board.
5.

Be sure:
You have your fingerprints captured at an in-state (NV) livescan location (recommended); OR
A fingerprint card is completed and the card is not folded, torn or damaged in any way.
The Information block is complete and legible
The card is signed by the appropriate persons (applicant and official)
The coded card (Form FD-258) provided by the Board is used exclusively

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Please note: If you have previously been fingerprinted for your place of employment or another board of nursing,
we are unable to use those results. Federal law prohibits the sharing of fingerprint information. You will need to
be fingerprinted specifically for the Nevada State Board of Nursing.

WARNING: Due to various factors, it may take up to four months for the Board to receive the official fingerprint results
from the Department of Public Safety and FBI. A permanent license/certificate will not be issued prior to receipt of both
fingerprint reports. A temporary license cannot be extended beyond the 6-month expiration date. You are urged to
fingerprint early in the application process.

Fingerprint Submission Form

Mail to: Nevada State Board of Nursing, 5011 Meadowood Mall Way #300, Reno, NV 89502-6547 (888-590-6726)
If you completed a fingerprint card: Complete and attach this form and a payment of $51.25 to your completed fingerprint card
(Form FD-258). You may pay by credit or debit card (MasterCard, Visa, Discover, or American Express), personal or cashiers check,
or money order, payable to the Nevada State Board of Nursing (NSBN), U.S. Funds only.
If you submitted fingerprints via electronic transmission: Complete this form and attach a copy of your receipt showing
payment for transmission.
First Name ________________________________________________Middle Name _______________________________________
Last Name________________________________________________________________ Date of Birth________________________
Address ____________________________________________________________________________________________________
City________________________________________________ State ___ Zip_________ Telephone Number __________________
Application Type:

RN
APN

LPN
CRNA

CNA

MA-C

EMS/RN

Licensed by:

Endorsement

Licensed by:

Other

Exam

Renewal

Renewal

If paying by credit or debit card, please complete:


Visa____ MasterCard___ Discover___ AMEX___ Card number___________________________ Exp. date_____
Name on card________________________________ Amount $51.25 Signature_____________________________

NURSING
Nevada State Board of

Instructions for Application


for RN/LPN License by Examination
Application Instructions
You must submit items 1-4 below:
1. Submit a completed and signed application form, including the applicable license and fingerprinting fees
(money order, cashiers or personal check, or MasterCard, Visa, Discover or American
Express debit or credit card) made payable to the Nevada State Board of Nursing. Fees are not
refundable. Please note: Applications will be accepted without a U.S. Social Security Number (SSN);
however A permanent license will not be issued without an SSN.
2. Apply to NCLEX Testing Service. The application is available online at
http://www.pearsonvue.com/NCLEX.
3. Order an official transcript of your nursing education program sent to the Board directly from the school.
The transcript must have your degree posted.
Nevada graduates
This requirement is fulfilled in two steps: 1) Your school will send the Board an affidavit of
graduation, which will make you eligible to receive an Interim Permit; and 2) You must order an
official transcript of your nursing education program sent to the Board directly from your school to
be eligible to receive a permanent license.
Out-of-state graduates
Order an official transcript of your nursing education program sent to the Board directly from the
school.
Graduates of international nursing programs
This requirement is fulfilled when the Board receives your CGFNS/CES* Professional Report for the
state of Nevada (see attached for more information for international graduates).
*Commission on Graduates of Foreign Nursing Schools/Credentials Evaluation Service

4. A completed fingerprint card (see separate instructions and submission form for information on how to
obtain and submit the fingerprint card). Note: a permanent license will not be issued until the Board
receives fingerprint reports from the Nevada Department of Public Safety and the Federal Bureau of
Investigation, and any issues have been resolved.
IMPORTANT!! Please do not send any documents before you submit
your application. The Board will not accept any required documents unless
they are submitted with (or after) your application.

Examination Information
Steps:

Submit items 1-4 (under Application Instructions above) to the Board.

Submit NCLEX application and fee separately to the NCLEX Testing Service, Pearson Vue. The
application is only available online at http://www.pearsonvue.com/NCLEX. Each examination attempt
will require a new Pearson Vue application and fee.

Once youve submitted items 1-3 (above) and the NCLEX application and fee, the Board will make you
eligible to test and you will receive an Authorization to Test (ATT) from Pearson Vue.
(continued)

After you receive your ATT, contact Pearson Vue to schedule a test date. You must test within 90 days of
receiving your ATT.

Examination Results
Although it is possible for applicants to obtain unofficial results, the Board cannot issue a permanent
license until your official results are received. Once received by the board, your written results will be
sent to your address of record.
The Board will not give you the results over the telephone.
Interim Permit
The Board may grant an Interim Permit to a first-time examinee after the Board receives the application
and documentation of graduation from an approved nursing education program. The Interim Permit
allows the examinee to practice as a Graduate Nurse only in the state of Nevada and only for 90 days.
The Interim Permit expires upon notification of examination failure, regardless of the time remaining on
the Interim Permit. Authority to practice as a Graduate Nurse then ceases.
Interim Permits will not be extended beyond the original 90 days of issue.

Broker/Third Party

If you wish to have a third party act upon your behalf for licensure purposes, please sign the authorization form,
have it notarized, and return it to the Board.

Qualifications for Nevada Licensure

1. You graduated from an approved school of nursing with a nursing certificate (LPN), or a diploma or
nursing degree (RN),
2. You passed the NCLEX licensing examination,
3. You have a U.S. Social Security number,
4. You have completed and submitted the fingerprint card, and
5. The Board has received and cleared your fingerprint reports.

General Information

Follow all instructions. All questions in all sections must be answered completely and the answers
legibly written. Incomplete applications will not be processed.

Your application for licensure is valid for one year from the date received by the Board. It is your
responsibility to follow up with the Board to determine the ongoing status of your application.

The address furnished on this application will become your address of record unless you indicate
otherwise.

You must notify the Board, in writing, within 30 days of any change in your address of record.

You may check to see if your license has been issued by visiting the license/certificate verification
section of our website www.nevadanursingboard.org. Nevada does not issue hard card licenses. No
license card will be mailed to you.

Time frame: As processing of your application is dependent on receiving documents from outside

sources, we are unable to provide specific time frames for processing. However, if your application is
complete and meets the criteria for issuance of a license/certificate, we can generally issue your
(temporary or permanent) license/certificate within one week of receipt of your application and
applicable documents.
5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6576 (fax) 775-687-7707
4220 S. Maryland Pkwy., Suite 300, Las Vegas, NV 89119-7524 (fax) 702-486-5803
www.nevadanursingboard.org 888-590-6726 nursingboard@nsbn.state.nv.us

rev. 11-21-13

RN/LPN Licensure By Examination Application


Additional Information for International Graduates

1.

*Nevada Requires CGFNS-CES


All graduates of international nursing schools must have their professional credentials (nursing
education and professional licenses) evaluated by the Commission on Graduates of Foreign Nursing
Schools (CGFNS). All international graduates must have the results of a CES Professional Report
mailed directly to: Nevada State Board of Nursing, 4220 S. Maryland Pkwy., #300, Las Vegas, NV
89109-7533.
Contact information for CGFNS
Address 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651, USA
Telephone (215) 349-8767
Fax
(215) 662-0425
Email
info@cgfns.org
Website www.cgfns.org
TELEX
402409 CGFNS PHA
Cable
CGFNS, Philadelphia, USA

2.

**Validation of English Language Proficiency


If you have graduated from a nursing program in a country or territory where the principle language is
English, i.e. Australia, United Kingdom, New Zealand, Canada (except Quebec), Ireland, Trinidad,
Tobago, South Africa, Ghana, Jamaica, Barbados, or United States/territory, you are NOT required to
validate your English language proficiency skills to obtain a license in Nevada.

If the principal language of the country where you completed your nursing program is a language other
than English, you are required to take and pass any ONE of the following options. You are required to
complete an English proficiency exam regardless of your country of citizenship, language of
instruction, or green card status.

1. The Internet based (IBT) TOEFL minimum passing score is 84 with a 26 in


spoken English.
For TOEFL testing information contact
Email
TOEFL@ets.org Website
www.toefl.org

OR

2. Pearson Test of English Academic with a minimum passing score of 55 and


no individual section below 50
For Pearson Test of English information Contact
Website www.pearsonpte.com/testme/pages/testcenters.aspx

All English language proficiency test results must be sent to the Nevada State Board of Nursing, 4220 S.
Maryland Pkwy., #300, Las Vegas, NV 89119-7533.

3.

For your quick reference, below is a list of the steps international


graduates need to take. Please do not use this as a substitute for carefully
reading and following the application instructions.

1)
2)
3)
4)
5)

Apply for the CGFNS-CES*.


Apply for validation of English language proficiency**
Complete and submit the application for RN/LPN licensure.
Complete and submit fingerprint cards.
After receipt of the CGFNS-CES report and English language proficiency, apply
to take the NCLEX.

You will not receive your Authorization To Test (ATT) until the Board has received your CGFNS-CES
Report and the results of your English Proficiency exam.

Other U.S. Agencies

U.S. Citizenship and Immigration Services (USCIS)


The Board does not act in any capacity on behalf of the applicant or his agent in their transactions with the
USCIS for the issuance of passports, visas or other related documentation. Immigration requirements may be
reviewed at www.uscis.gov. The Board does not issue any letters on behalf of the applicant or his agent in their
transactions with the USCIS. The Board does not sponsor applicants.

U.S. Department of Labor (DOL)


The Board does not act in any capacity on behalf of the applicant or his agent in their transactions with the DOL
for the issuance of work or other related documentation.

U.S. Social Security Administration (SSA)


Nevada Revised Statute (NRS) 632.3446 requires the applicant to provide a U.S. Social Security Number (SSN)
for the issuance of a license. Clarification of the SSA process may be reviewed at www.ssa.gov. The Board
does not act in any additional capacity on behalf of the applicant or his agent in their transactions with the SSA.
A permanent license will not be issued without proof of the applicants U.S. social security number.

U.S. State Department, Embassies and Consulates


The Board does not act in any capacity on behalf of the applicant or his agent in their transactions with U.S.
State Department, Embassies or Consulates for the issuance of passports and visas.
02-19-2014

WEB

WEB

Application for Initial License

Return to: Nevada State Board of Nursing, 5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6576
(888) 590-6726, fax (775) 687-7707, nursingboard@nsbn.state.nv.us
www.nevadanursingboard.org
To practice nursing in Nevada, you must hold an active Nevada license.
License Type

Registered Nurse
Licensed Practical Nurse

First Name

Social Security #

Application Type

Middle Name

Last Name

Place of Birth

Date of Birth

Telephone #

By Endorsement
By Examination

Apt. #

Address (if you move, you must notify the Board within 30 days in writing, or via the Board's website)

Male
State

City

Female

ZIP

Email Address
If you wish to apply for a Nevada nursing license, please answer all questions, sign the application, and include the fee.
Incomplete applications will be returned to you for completion.

It is a violation of Nevada law to falsify this application, and sanctions may be imposed for fraud or misrepresentation.

Previous Names Used

(Please list any previous last names used. Attach a separate piece of paper if necessary.)

2.

1.

Section 1. Nursing Education and Examination Summary


Nursing program

(that qualified you for initial nurse


licensure)

School

Date Graduated

Degree/Diploma

Date

License#

Location
Licensed by NCLEX
examination

State

For endorsement applicants


and graduates of foreign
nursing schools

I last practiced nursing on this date?

(your original state of licensure)

In what state?

You must indicate a date. Phrases such as TODAY, CURRENTLY, PRESENTLY, STILL PRACTICING, etc.
will cause a delay in processing your application.

For examination applicants and


graduates of foreign nursing
schools

Have you taken the NCLEX


examination in any other state(s)?
Yes
No
(continued)

If yes, what state(s)?

If yes, how many times?

Section 2. Application Screening Questions


(If you answer Yes to any of Questions 1 through 5 below, you MUST submit the required documents to avoid delays in
processing your application.)
Yes

No

1. Has your application, or your license, registration, certificate or privilege to practice in any jurisdiction, of any level
(does not include drivers license or car registration)

a. Ever been denied?


b. Ever been disciplined including but not limited to reprimanded, censured, fined, suspended, revoked, limited
or restricted, or placed on probation or monitoring?
c. Ever been subject to a non-disciplinary probation or monitoring program?
d. Are you the subject of a current investigation or inquiry in any state or jurisdiction?
e. Are you the subject of a pending hearing, settlement or action in any state or jurisdiction?
If any answer is Yes, you must submit the following:
a. A detailed letter of explanation that includes the state or jurisdiction where the action occurred or is pending
and
b. Copies of documents from the state or jurisdiction where there has been action, a current investigation or
inquiry
Yes

No

2. Have you ever had a criminal conviction, including a misdemeanor or felony, or had a civil judgment rendered
against you?
If the answer is Yes, you must submit the following:
a. A detailed letter of explanation including the circumstances leading to your conviction, date convicted, actual
conviction (i.e. DUI, theft, etc.), what your sentence was, and if and when you completed it;
b. Copies of court documents, including the actual conviction, sentence, and current status of sentence (i.e. all
fines paid in full, completion letter from Parole/Probation Officer, etc.) or a letter/form from the court indicating
no records are available;

Yes

No

3. Do you currently use chemical substances in any way which impairs or limits your ability to practice the full
scope of nursing?
If the answer is Yes, you must submit:
a. A letter of explanation that addresses the impairment or limitations of practice;
b. If you are using the chemical substance as a confirmed medical necessity, a letter from your treating
practitioner documenting the diagnosis and medical necessity for the use of chemical substances, including any
practice limitations.

Yes

No

4. Are you currently in recovery for chemical dependency, chemical abuse or addiction?
If the answer is Yes, you must submit:
a. A letter of explanation describing your recovery experience, including length of continuous recovery,
treatment, and current recovery activities;
b. Documentation from knowledgeable individual(s) documenting your length of sobriety; and
c. Documentation of inpatient or outpatient chemical dependency treatment.

Yes

No

5. Do you currently have a medical or psychiatric/mental health condition which in any way impairs or limits your
ability to practice the full scope of nursing?
If the answer is Yes, you must submit:
a. A letter of explanation regarding your condition, whether temporary or permanent, including diagnosis, past
hospitalizations, date of last treatment, current treatment plan, and how your condition may interfere with your
ability to practice the full scope of nursing safely; and
b. Documentation from treating practitioner regarding the diagnosis, (Axis I-V for psychiatric diagnosis),
medications, current status and treatment plan, the extent of condition, and statement regarding your ability to
carry out nursing duties reliably and with good judgment.

(continued)

Section 3. Child Support Information


Yes

No

I am subject to a court order that requires me to pay for the support of one or more children.

Yes

No

N/A

I am in compliance with that court order. (If you answered No to the question above, mark N/A)

Section 4. Safe Injection Practices.


Yes

No

I affirm (swear) that I have knowledge of and am in compliance with the guidelines of the Centers for Disease
Control and Prevention concerning the prevention of transmission of infectious agents through safe and
appropriate injection practices.

Affirmation
I affirm (swear) that I have read this application and the statements made are true and correct.
Signature

Date

Fee Schedule
RN by endorsement

105.00 (includes $5 fee for

RN by examination
LPN by endorsement

100.00
95.00 (includes $5 fee for

Before you submit your application,


please make sure you

national database check)

national database check)

LPN by examination
90.00
You may pay by credit card (MasterCard, Visa,
Discover, American Express) personal or cashiers
check, or money order, payable to the Nevada State
Board of Nursing (NSBN). U.S. Funds only. Please
note: If you do not submit the required fees, your
application will be returned to you, unprocessed. All
Fees are non-refundable.

have answered ALL the questions in the top portion and


Sections 1 through 4, and
signed the Affirmation
have submitted all required documentation (see attached
instructions for list of documents)
have submitted the correct fee
verify your current mailing address
complete the fingerprint requirement

WEB
If Paying By Credit Card, Please Complete
Visa

MasterCard

Name on card

Discover

American Express
Amount $

Card number
Signature

Exp. date

NURSING
Nevada State Board of

Third-Party Authorization
If you would like someone other than yourself to act as your representative in the
licensure process for this application, please complete this form and have your signature
notarized. Discard this form if you are submitting the application for yourself and do not
want another person to act on your behalf.
I, __________________________________________, the undersigned, do hereby
authorize ___________________________________ , whose address is
_______________________________________________________________________,
his/her agents or employees, to act for me and in my name with respect to my application
for licensure with the Nevada State Board of Nursing, as follows:
(Check only those items which apply)
________ 1. File my application
________ 2. Pay my application fee
________ 3. Act as my representative on all matters with the Board of Nursing

Date

State of

Signature

____________________________

County of ____________________________
This instrument was acknowledged before me on

by ______________________________________________________

SEAL

Notary Public

5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6576 (fax) 775-687-7707
4220 S. Maryland Pkwy., Suite 300, Las Vegas, NV 89119-7533 (fax) 702-486-5803
www.nevadanursingboard.org 888-590-6726 nursingboard@nsbn.state.nv.us

rev. 04-04-12