Annual Report Forms – Contact Board of Nursing office 6 and ask to speak with the LPN/RN Clinical Program Specialist.Initial program approval documents: Contact Board of Nursing office 6 and ask to speak with the LPN/RN Clinical Program Specialist.LNA Competency Testing Accommodation RequestĮducation: Pre-Licensure RN, LPN, and Out of State Programs.Pre-Approval Application for Nursing Assistant Competency Testing.MNA Program Clinical Facility Site Visit Criteria Attestation.MNA Education Request for On-Site Visit.Nursing Assistant Education Program Evaluation Crosswalk.Provide a copy of the Current Facilities Inspection Report available online at URL:.Provide copy of the clinical agreement for board office records.Application for Approval of Cooperating Agency.LNA Program Clinical Facility Site Visit Criteria Attestation.Clinical Site Approval (Cooperating Agency).Initial program approval documents: Contact Board of Nursing office 6 and ask to speak with the LNA/MNA Clinical Program Specialist.Be sure to sign and date the and include the correct application fee.Įducation Programs: Nursing Assistant and Medication Nursing Assistant.Applications not completely filled out will be returned to you as incomplete. Note: If the answer is none or N/A, please state so.Respond to all questions and fill in all requested information.Be sure that the form prints completely, making sure that all text is legible, and all boxed content, seals and symbols are displayed.Please use quality paper for printing the applications (white 8 1/2 x 11 inch paper must be used).Most license applications may be completed using the online licensing system as opposed to the "paper forms" below.All completed, signed forms are legal documents and must be reproduced as they appear.The Board of Nursing defines "practicing" as including attendance at orientation or completing other types of non-director care activities. No person may practice as a nurse or nursing assistant without a license. New Hampshire has a mandatory licensing law.To apply for relicensure, log into MiPLUS then select "Modification" next to your license number and then select "Relicensure.Board of Nursing Home Important Information for all Licensees.To change your name and/or address on your license, to order a reprint, add a specialty to your license or file for relicensure, log into MiPLUS then select “Modification” next to your license number. ![]() For instructions on using your PIN for pharmacies click HERE and for other businesses click HERE. Please wait to receive your PIN letter and instructions before setting up your MiPLUS Account.
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