Application Forms - Six Month Limited Permits

Six-month temporary permits are issued to nurses who have not been employed as a Licensed Vocational Nurse during the past four years and are used for the purpose of completing a refresher program, extensive orientation, or a nursing program of study under the supervision of an RN Instructor. In order to renew or be issued a license, you must successfully complete ONE of the following:

(a) A refresher course, which is defined as an organized course for Vocational Nurses designed to update nursing knowledge, and which meets all content criteria as indicated on the attached form;

(b) An extensive orientation to the practice of vocational nursing which meets all content criteria as indicated on the attached form; or

(c) Academic nursing course(s), in an approved vocational nursing education program, which meets all the content criteria as indicated on the attached form.

The temporary permit will be valid for six-months from the date of issuance. The permit cannot be extended!

Please be sure that you are prepared to begin and complete the course, orientation, or nursing program of study within the required time limit.

LVN Refresher Course Completion Form

Six-month temporary permits are issued to nurses who have not been employed as a Registered Nurse during the past four years and are used for the purpose of completing a refresher program, extensive orientation to the practice of nursing, or a nursing program of study under the supervision of an RN Instructor. In order to reactivate or be issued a license, you must successfully complete ONE of the following:

(a) A refresher course, which is defined as an organized course for Registered Nurses designed to update nursing knowledge, and which meets all content criteria as indicated on the attached form;

(b) An extensive orientation to the practice of Registered Nursing which meets all content criteria as indicated on the attached form; or

(c) Academic nursing course(s), in an approved Registered Nursing education program, which meets all the content criteria

RN Refresher Course Completion Form

A six month temporary APRN permit may be issued for one of the following purposes:

(a) obtaining 400 hours of practice in the APRN’s role and population focus area under direct supervision, because the APRN has not completed 400 hours of practice in the APRN’s role and population focus area within the last 24 months;

(b) completing a refresher course/extensive orientation because the APRN has not practiced in the APRN’s role and population focus area within the last four years.

The six month temporary APRN permit will be valid for six months from the date of its issue. The permit time cannot be extended! Please be sure that you are prepared to begin and complete your supervised practice hours, refresher course/extensive orientation, or academic course within the time period allotted.

APRN Completion form for those out of practice less than 4 years

APRN Refresher Course Completion form for those out of practice over 4 years