What do I do next? You cannot request a name change through the online portal. (PDF), "Out of State Exemption" and mail it to the address indicated on the form. Please reference the board or program that your business or entity is associated with looking for the specific program's application and forms page. We must have your current mailing address in our system. There is no fee to record your name or address change if you do not want a revised copy of your license. You will receive an updated copy via e-mail, once the change has been completed. Step 3: Register with PearsonVUE to take the NCLEX. Last 30 Days. Social Security number. Customer Service Office The Order will disclose the hearing date, time, and any other pertinent information. You may use these instructions to update your contact information online. Deputy Secretary for Quality Assurance. If your contact information isn't current in our system, please complete and submit the contact information change form. Please enable scripts and reload this page. Your duplicate product will be issued with the corrected address. CRNPs with Prescriptive Authority - Requirements Under Act 124 of 2016 Opioid Education for Renewals Submitted After July 1, 2017 (PDF) Continuing Education Frequently Asked Questions Inactive Status Information (PDF) Contact State Board of Nursing P.O. Complete the Petition for Change of Name of Minor Form and theOrder of Publication Form (blank except for the minors name), and make copies of each form. Step 1: Complete the Personal Status Change Application (PDF) RN CE Sponsor. Form 2 - Certification of Professional Education (If applicable) ( 28 KB) Board Rule 217.7 requires name and address changes to be submitted to the Board in writing. In order to practice nursing in Rhode Island, you must obtain a Rhode Island nursing license. If you are moving out of state and qualify for a residency exemptionfor a change of address to your driver's license,please fill out Form DL- 82 (PDF), "Out of State Exemption" and mail it to the address indicated on the form. Divorce decree. Note: Application forms provided can no longer be filled out on the computer and printed. We are open to the general public as follows: Monday, Tuesday, Thursday and Friday from 8:30 am - 4:30 pm. Hearings usually wont be scheduled until forty-five (45) days after you have filed your name change petition to allow time for the Notice of Name Change to be published in the newspapers. Each county in Pennsylvania has a slightly different process, and may include additional forms. Download the Decree for Change of Name Form (also referred to as an Order of Name Change or a Judgment of Name Change) and bring it to your hearing along with both proof of publication notices and your name search certifications. Individuals who withdraw their licensure application may be entitled to a partial refund.. For the procedure to withdraw your application, contact the Nurse Unit by e-mailing opunit4@nysed.gov or by calling 518-474-3817 ext. You can send the documentation to: - Fax: 317-233-4236 Attn: Nursing Group - Email: pla2@pla.in.gov - Address: IPLA If you send an e-mail or leave a voicemail message, please include your license number (if you have one), what you are trying use the site for, and your telephone number or e-mail . Submit Business License: Owner's Legal Name Change (form 08-4104) along with the appropriate fees. Social security cards are NOT acceptable. Please enable scripts and reload this page. As of June 11, 2018, at 12:01 a.m. CST, any nurse with the multi-state privilege will no longer be able to practice nursing in the state of Rhode Island under the Nurse Licensure Compact (NLC) or the Enhanced Nurse Licensure Compact (eNLC). You will have to explain the reasoning behind the name change, even if it was mentioned in the Petition, and assure the judge that it is in the childs best interest. Educational setting . If you plan on renewing online, we must have your current name in our system prior to renewal. Upon updating your address for your non-commercial driver's license, learner's permit or PA photo ID card,you will receive a freeaddress update card within 10 days after the change has been made online. A Pennsylvania name change form is to be completed by an applicant petitioning for a name change through their countys Court of Common Pleas. For orders prior to this date, search for the licensee / certificate holder using Lookup a License. In order for a minor to be approved of a name change, they must be clear of any judgments or decrees of record against them. However, you must conduct your own search at the Recorded of Deeds Office and prepare the certification yourself (use the aforementioned certification forms as examples). Complete the required form and visit your countys DMV offices. Reply ; M. Dedicated April 2019 . The deadline can be 20, 30, or even 45 days prior to the hearing date;check with your countys court clerk to confirm the deadline. You can also update your address 24/7. At least that is how it is done in my state. apply for licensure by endorsement apply for licensure by reinstatement. photographic identification as proof of name change. Wednesday from 9:30 am - 4:30 pm . of Health for the new sponsor or name change is attached . They will conduct an official name search of the minor and, if no judgments exist, they will sign a certification (for a small fee usually around $10) that you can bring to the hearing. Notification Regarding Online LOGS Requests (PDF), Acting Secretary Leigh M. Chapman's Twitter. Board of Nursing: Please email your name or address change request to: bon.dc@dc.gov. Transferring your nursing license to another state doesn't need to be a huge hassle. Harrisburg, PA 17120-0701. You may need to submit an affidavit attesting to the mistake and indicating the correct spelling of your name, in addition to other information. These changes may be submitted by using the Nurse Portal and uploading applicable supporting documents. Please mail, email, or fax a copy of your certified marriage certificate, divorce decree or court order showing your name change to the Customer Service Office. 717-525-5506 (fax) RA-DHDEPSECQA@pa.gov. Changing the name of a minor (person under eighteen (18) years of age) is much like the adult name-changing process, but also requires the consent of (typically) both parents. Download and complete the Publication Notice Form and submit it to two (2) newspapers in the county where the minor resides. NOTIFICATION OF NAME CHANGE . Most states require nurses to hold a valid and active license and to have passed the NCLEX-RN exam. Name may only be 32 characters including spaces. An adult may petition for a name change for personal reasons, which involves a much lengthier process. Renew a Facility License Change my name on my professional license Change my address (not for a business) Obtain a certification or verification of a license File a complaint View disciplinary actions View Facility Rosters Licensure Unit Department of Health & Human Services/Division of Public Health/Licensure Unit Phone Number (402) 471-2115 Professional Nursing Professions Licensed by IDFPR: Registered Professional Nurse (RN) Licensed Practical Nurse (LPN) Advanced Practice Nurse (APN) Advanced Practice Registered Nurse- Full Practice Authority (APRN-FPA) APRN - FPA Controlled Substance. I mean, in terms of giving up the name you used while earning your hard earned nursing degree, and the name that was on your RN license, if you got it before marriage. Make sure to bring valid ID with your new name on it. You will need your Application ID and Date of Birth. Toggle navigation. Incredible Health offers Pennsylvania-licensed nurses free continuing education units and instant certificates to help you complete your requirements. New graduates take the You will be asked a series of questions and you will have to have a driver's license or ID with your new name on it. If you are requesting changes through paper application, you need your: License number Social Security Number Date of birth For a name change You must return the original hard copy of your license and submit a copy of supporting documents. They will take the minors fingerprints on a Fingerprint Card (see an example here) and, most likely, charge you a small service fee. Attention: Name and Address Change Department For certified nursing assistants, certified medicine aids, and certified medication technicians: (410) 764-8042 If consent is not obtainable, you must send copies of both the Petition and the Order of Publication to the parent(s) by regular and certified mail. Name Change If your name has changed since your license was issued, you have the following options: Wait until your next license application or renewal to update your name. You may be required to present your Social Security Card as well as two (2) other documents with your new name on it. Failure to receive the notice for renewal will not relieve you of the responsibility of renewing your license by the expiration date. Laboratory Name This is the name that will be used for all aspects of the facility (billing, etc.). Each county has a different policy regarding the number of days the Notice must be published before the hearing date. P.O. Probate Court Document. This will be used to update your name change with various state and federal agencies. Bring the Petition, Fingerprint Card (if applicable), Order of Publication, and a copy of the minors birth certificate to the County Court of Common Pleas where the minor resides. Visit the court clerk and have them make certified copies of the Decree so you can update the minors name change on any necessary documents and identifications. To apply for a non-commercial driver's license online, applicants must have their photo and signature on file with the agency. Furthermore, you cannot change your name to something that could affect the rights of another person, and you cannot use a curse word, racial slur, or offensive language in your new name. Territory or Canada, you may apply for a TPP. Renewal Check. On the date of the minors name change hearing, bring the proofs of publication, the certifications, the signed Consent Form (or signed return mailing receipts), and the Decree for Change of Name of Minor Form. You may also choose to obtain a duplicate non-commercial license or Photo ID for a fee at the time of your address change. Sign your marriage license using your new name and, once the license is filed with the county courthouse, you will receive a certified copy of your marriage certificate. 0 Likes. You won't be sent a credential showing your new name until your next renewal has been processed. You still must submit your licensure fee and any other associated fees. You may be trying to access this site from a secured browser on the server. The source ID document(s) are considered the most recently issued Department of Homeland Security immigration document(s), not a Passport, Visa, or Marriage Certificate. Attention: Name and Address Change Department . Improve customer satisfaction with state services, Improve government efficiency and employee engagement, Help keep people safe in their communities and on Pennsylvania's roads. PennDOT may not issue driver license products to an out-of-state address, except in the case of an employee of federal or state government, armed forces personnel or their families, who workplace is located outside of Pennsylvania. Download and complete the Application To Change/Correct/Replace form. Go to the Business Licensing Section , and click Renew Alaska Business License. Online: Go to www.votespa.com and click 'Update Your Registration'. allnurses.com, INC , 7900 International Drive #300, Bloomington MN 55425 If educational setting, the approval from PDE Division of Higher and Career Education for a private licensed school is attached Former sponsor: Former sponsor mailing address: Telephone: County: B. Submit a completed Nursing license name, address, or email change form along with a photocopy of supporting documents that prove your legal name change. The Pa. Board of Nursing's review page is loaded with one complaint . Bring your marriage certificate, divorce decree, or a certified copy of the Decree for Change of Name, depending on your situation. This Notice must be published in two (2) newspapers in your county or a county contiguous to your county. The entity will need to submit a paper application/form for this change to be effective. Shortly after you file the Petition, you will receive the Order of Publication in the mail from the courthouse. Our support agents are standing by to assist you. apply for licensure by examination. Learn more. Quality Assurance. Side B should be completed if you are requesting an updated vehicle/trailer title. The following forms will have to be completed and filed with your countys Court of Common Pleas (do not complete all forms at once follow the stepscarefully): Download the Petition for Change of Name Form and fill it out. This is especially important because we mail your courtesy renewal notice and updated credential to the address on file. Similarly, changing ones name after marriage is as simple as entering the new name on the marriage certificate. Once you receive the Order of Publication from the court, download two (2) Publication Notice Forms (also referred to as a Notice of Hearing) and fill out all appropriate information. Complete the Notice to Resume Maiden Name Form and sign it in front of a notary public. Contact our staff members if you have any questions. Change my address on my license. Bring a copy of your birth certificate (to show proof of maiden name) and a copy of your divorce decree. Not all counties require cover sheets, whereas other counties require a Civil Cover Sheet, a Court Administration Cover Sheet, a State Cover Sheet, or a combination of the three. Box 656 Jefferson City, MO 65102-0656 Express Mail Address 3605 Missouri Boulevard Jefferson City, MO 65109 573.751.0681 Telephone 573.751.0075 Fax 800.735.2966 TTY 800.735.2466 Voice Relay nursing@pr.mo.gov https://pr.mo.gov/nursing.asp Driving Directions 2022 Electronic Forms LLC. File these documents with the Prothonotarys office and pay all associated fees (typically around $100). Most licenses issued by the Professional Licensing Agency can be renewed online. How can I obtain a Registered Nursing license in Georgia? If your name changed by permission of court, you must present a Certified Copy of the Court Order. (e.g., driver license, alien registration, passport, etc.) Please be advised that the application fee for Professional and Practical Nurses and Advanced Practice Nurses who apply for a plenary license in the State of New Jersey from July 1, 2022 and through June 30, 2023, will be waived. Side A of the form should be completed if you are only requesting an updated vehicle/trailer registration card. Answer: You are legally required to notify the New York State Education Department (NYSED) of your name and/or address change within 30 days. By law, you can start using your maiden name immediately after filing the notice. The clerk will ask you to pay all associated filing fees (fees can range anywhere from $100 to over $300). If youve recently changed your name after marriage, after divorce, or for any other reason, you should update your drivers license (or photo ID card) as soon as possible. Board of Nursing Complaint Process: Investigation to Resolution 1801 Congress Avenue, Suite 10-200 Austin, TX 78701 | P: (512) 305-7400; | F: (512) 305-7401 To protect and promote the welfare of the people of Texas. All Other Boards: Please email your name or address change request to: doh@dc.gov. File the Decree with the Prothonotary and ask for a certified copy. If you are moving out of state and qualify for a residency exemptionfor a change of address to your driver's license. Updating your voter registration after a name change is a relatively quick and painless process that simply requires you to re-register to vote. Step 4: Submit an online application to the Board. You may wish to change your name for a multitude of personal reasons. Not want a revised copy of your Birth certificate ( to show proof of maiden name form and it...: complete the Publication Notice form and submit the contact information online of name, on... 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