Forms and Publications

Forms

Consumers

Document Title
Consumer Complaint Form

Applicants

Document Title
Application for Psychiatric Technician Licensure by Examination
Application for Vocational Nurse Licensure by Endorsement
Application for Vocational Nurse Licensure by Examination
Authorization for Release of Confidential Information - (55P-6)
Authorization for Release of Confidential Medical Records and Information - (55P-5)
PT Employment Verification

Licensees

Document Title
Address Change Request Form - (55P-4)
Application for Renewal
Employer Mandatory Reporting Form
Employment Verification - Nursing Experience - (55A-12)
Fee Schedule
Licensee Mandatory Reporting Form
Name Change Request Form - (55P-3)
Notice on Collection of Personal Information For Applicants and Licensees

Education

Document Title
55M-1 Letter of Intent to Submit Application for Initial Approval of New School or Program Vocational Nursing
55M-2 Application for Approval of New School or Program of Vocational Nursing
55M-2E Summary of Instructional Plan Program Hours Vocational Nursing Program
55M-2W Vocational Nursing or Psychiatric Technician Program Curriculum Content Instructional Plan
55M-3 Intent for Clinical Placement
55M-3A Clinical Facility Verification Form VN
55M-10 Verification of Faculty Qualifications Form
55M-15 Continuing Approval Application for a Vocational Nursing School or Program
56M-1 Letter of Intent to Submit Application for Initial Approval of New School or Program Psychiatric Technician
56M-2 Application for Approval of a New Psychiatric Technician School or Program
56M-2E Summary of Instructional Plan Program Hours Psychiatric Technician Program
56M-3A Clinical Facility Verification Form PT
56M-15 Continuing Approval Application for a Psychiatric Technician School or Program

Enforcement

Document Title
How To File A Complaint
Employer Mandatory Reporting
How an Arrest Affects Your License
Licensee Mandatory Reporting

Publications

Document Title
Approved School Lists
Disciplinary Action Lists
Fact Sheet (Out-of-State Applicants)
Licensed Vocational Nurse Fact Sheet
Strategic Plan