Forms

Our applications and forms (processing FEES listed below) are available to you at any time by using your browser "Print" button, or contact us at:

West Virginia Board of Examiners
for Registered Professional Nurses
101 Dee Drive, Suite 102
Charleston, WV 25311-1620
Phone: (304) 558-3596 or 1-877-743-NURS(6877)
Fax: (304) 558-3666
Web Address: www.wvrnboard.com Email: rnboard@wv.gov

For the vision impaired, all forms are available at (304) 558-3596 in another format.

NOTE: Any forms in .pdf file format may be viewed, downloaded or printed using the free Acrobat Reader. You only need to get Acrobat Reader ONCE; thereafter any .pdf files on the Web are available for download and printing on any computer platform with any printer. Be sure to use the most recent version! to avoid any error messages...If you've never downloaded the Acrobat Reader before...

Index of Applications

Advanced Practice Application	For individuals desiring to apply for announcement of advanced practice a separate advanced practice license is NOT issued. A letter announcing advanced practice approved by the Board is issued. National Certification in an area approved by the Board and a masters in nursing are required.
Endorsement Application	(1) National Council Verification Form .pdf (2) State Board Verification Form .pdf
Annual License Renewal Application	Forms will be mailed in September in the RN Magazine; please call the Board or download/print out our .pdf copy if you do not have one. NOTE: After 10/31, use the Reinstatement Form.
Midwife Applications	Initial License Application for Certified Nurse Midwife Renewal Application for Certified Nurse Midwife
Prescriptive Authority Application	Registered professional nurses holding advanced practice approval by the Board may apply for prescriptive authority.
Reinstatement Application	To reinstate from inactive or lapsed status.
Registration for Providers of Continuing Education Activities	To be a provider of continuing education.
Lost License	Affidavit validating you do not have possession of the license card issued to you.
Name Change	Affidavit legally changing your name.
Address Change	Written notification within 30 days of an address change.
Complaints

Fees:

Address Change	No Charge
Duplicate License	$5.00
Endorsement	$60.00 (Money Order or Cashier's Check)
Endorsement with Temporary Permit	$70.00 (Money Order or Cashier's Check)
Licensure by Examination	$51.50 (Money Order or Cashier's Check)
Advanced Practice	$35.00
Limited Prescriptive Authority	$125.00
Midwife Application	$20.00
Midwife Renewal	$10.00
Name Change	$5.00
Name Change with License Replacement	$10.00
Reinstatement from Lapsed Status	$75.00
Reinstatement from Inactive Status	$25.00
Transcript Photocopy	$5.00
Verification to Another Nursing Board or Certification Body	$30.00 (Money Order or Cashier's Check)
Working Without a Valid License	Disciplinary fees

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