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General Forms & Applications
Credentials/Language Evaluation Services
Change of Name/Address Request
Complaint Form
Facility Credit Card Authorization Form
Fingerprint Verification Form
Issue Review Request Form
Limitation of Liability for Practice
Mailing List Request Form
Map to OSBN Office
Non-Oregon Based Programs Offering Clinical Experience in Oregon
NURSYS License Verification Form
Presentation Request Form--Nurse Practice Act Presentations​
​Verification of Current Licensure
Verification of Original Licensure
RN/LPN Forms & Applications
NCLEX Exam Application for US Graduates
NCLEX Exam Application for Non-US Grads
Re-Examination Application (for NCLEX)
Endorsement Application for US Graduates
Endorsement Application for Non-US Grads
Fingerprint Verification Form
​Inactive Status Application Form
Nursing Education History Form
Nursing Practice History Form
Renewal/Reactivation Application for RNs, LPNs, and APRNs (LIC-101)
Retired Status Application​
RNFA Registry Application
CNA/CMA Forms & Applications
CNA 1 Exam Application
Renewal/Reactivation Application for CNA1 or CMA (LIC-701)
CNA 1 Endorsement Application Packet
CNA/CMA Application for RNs & LPNs
Fingerprint Verification Form
List of CNA Registries by State
CMA Exam Application Packet
CMA Continuing Education form (extra)
Student Nurse CNA Application
Advanced Practice Forms
Renewal/Reactivation Application for RNs, LPNs, and APRNs (LIC-101)
CNS Application Packet
Continuing Education Documentation Form
CRNA Application Packet
Dispensing Authority Application
Dispensing Self-Assessment Test
DEA Address Change Form
DEA Duplicate Certificate Request Form
DEA Schedule Change Requests
Fingerprint Verification Form
Malpractice/Negligence Claim Report Form
National Provider Identifier
Nurse Practitioner Application Packet
Prescriptive Privilege: Approved Courses
NA/MA Education Forms
CNA Exam Accommodations
LPN Clinical Preceptor Guidelines ​​(For NA/MA Programs)
NA, MA and Level-2 Instructor Application
NA/MA/CNA2 Training Program Application
RN/LPN Education Forms

Nursing Faculty Appointment Form (Word)

Candidate List for PN/RN Nursing Program Graduates
Re-Entry Preceptor Application (Word)