For Office Use Only: For Office Use Only:

Texas Board of Nursing

333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 FBI HX: [ ] Yes [ ] No
Amount __________________
Phone: 512-305-7400 -- Web Site: [Link] Temp Lic#________________

Date Recd_________________ Endorsement Application for Registered Nurses Texas Lic#_______________

SECTION A: Applicant Information

1) Last Name (Print): First Name:

2) Middle Name (will appear on license): Previous Name(s):

3)
(Address) (City) (State/Country) (Zip/Postal Code)

( )
(E-Mail Address) Phone Number

Social Security Number: - - Date of Birth: / /

Mo Day Yr

Gender: [ ] Male [ ] Female Ethnicity: [ ] African American [ ] Asian [ ] Caucasian [ ] Hispanic [ ] Native American [ ] Other

4) Name of BASIC Nursing School Attended: [Link]: /

Mo Yr

5) Location of Nursing School:

(City) (State/Province) (Country)

6) Type of Basic Education Program: [ ] Diploma [ ] Associate Degree [ ] Baccalaureate Degree [ ] Masters Degree [ ] Other

7) Indicate which of the following registered nurse examination(s) you have written and passed?

[ ] SBTPE - State Board Test Pool Examination [ ] NCLEX - National Council Licensure Examination

Date: Location:

8) List ALL STATE/PROVINCES/TERRITORIES/COUNTRIES that you hold or have held a permanent license as a Registered Nurse:

License Number State/Province/Territory/Country License Number State/Province/Territory/Country

License Number State/Province/Territory/Country License Number State/Province/Territory/Country

License Number State/Province/Territory/Country License Number State/Province/Territory/Country

License Number State/Province/Territory/Country License Number State/Province/Territory/Country

List additional State/Province/Territory/Country licenses on line above

SECTION B: Nurse Compact Declaration

9) In accordance with the Nursing Practice Act, section 304.001, art. 4 and 22 TAC §220.2, I declare that the State of
is my primary state of residence and that such constitutes my permanent and principal home
for legal purposes. (“Primary state of residence” is defined as the state of a person’s declared fixed permanent and principal
home for legal purposes; domicile.)

10) Upon licensure in Texas, in which state(s) do you intend to practice?

[ ] No [ ] Yes Are you currently employed in the U.S. Military (Active Duty) or the U.S. Federal Government?

Applicant’s Signature: Date: / / Page 1 of 2

 Endorsement Application for Registered Nurses Page 2 of 2

Applicant’s Name (PRINT): Social Security Number: - -

SECTION C: Eligibility Questions
11) [ ] No [ ] Yes Have you been practicing as a registered nurse within the past four (4) years?

12) [ ] No [ ] Yes Have you ever held a Texas Registered Nurse License?

13) [ ] No [ ] Yes For any criminal offense, including those pending appeal, have you:
A. been convicted of a misdemeanor?
B. been convicted of a felony?
C. pled nolo contendere, no contest, or guilty?
D. received deferred adjudication?
E. been placed on community supervision or court-ordered probation, whether or not adjudicated guilty?
F. been sentenced to serve jail or prison time? court-ordered confinement?
G. been granted pre-trial diversion?
H. been arrested or have any pending criminal charges?
I. been cited or charged with any violation of the law?
J. been subject of a court-martial; Article 15 violation; or received any form of military judgment/
punishment/action?

(You may only exclude Class C misdemeanor traffic violations.)

NOTE: Expunged and Sealed Offenses: While expunged or sealed offenses, arrests, tickets, or citations need not be disclosed, it is your
responsibility to ensure the offense, arrest, ticket or citation has, in fact, been expunged or sealed. It is recommended that you submit a copy
of the Court Order expunging or sealing the record in question to our office with your application. Failure to reveal an offense, arrest, ticket,
or citation that is not in fact expunged or sealed, will at a minimum, subject your license to a disciplinary fine. Non-disclosure of relevant
offenses raises questions related to truthfulness and character.
NOTE: Orders of Non-Disclosure: Pursuant to Tex. Gov’t Code § 552.142(b), if you have criminal matters that are the subject of an order
of non-disclosure you are not required to reveal those criminal matters on this form. However, a criminal matter that is the subject of an order
of non-disclosure may become a character and fitness issue. Pursuant to other sections of the Gov’t Code chapter 411, the Texas Nursing
Board is entitled to access criminal history record information that is the subject of an order of non-disclosure. If the Board discovers a criminal
matter that is the subject of an order of non-disclosure, even if you properly did not reveal that matter, the Board may require you to provide
information about any conduct that raises issues of character.

14) [ ] No [ ] Yes Are you currently the target or subject of a grand jury or governmental agency investigation?

15) [ ] No [ ] Yes Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of,
suspended, placed on probation, refused to renew a professional license, certificate or multi-state privilege held by you now
or previously, or ever fined, censured, reprimanded or otherwise disciplined you?

16) [ ] No [ ] Yes *Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug?

17) [ ] No [ ] Yes *Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia and/or psychotic
disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder?
If “YES” indicate the condition: [ ] schizophrenia and/or psychotic disorders, [ ] bipolar disorder,
[ ] paranoid personality disorder, [ ] antisocial personality disorder, [ ] borderline personality disorder

*Pursuant to the Occupations Code §301.27, information regarding a person’s diagnosis or treatment for a physical condition, mental condition,
or chemical dependency is confidential to the same extent that information collected as part of an investigation is confidential under the Occupations
Code §304.466.

NOTE: If you answered “YES” to questions 13 - 17 listed above, attach a letter of explanation that is dated and signed indicating the circumstance
you are reporting to the Board.

Attestation/Consent to Release & Use of Confidential Records

I, the Nurse Applicant whose name appears within this application, acknowledge this is a legal document and I attest that I understand & meet all
the requirements to practice for the type of licensure requested, as listed in 22 Texas Administrative Code, §§ 217 (Licensure, Peer Assistance and
Practice). Further, I understand that it is a violation of the 22 Texas Administrative Code, §§ 217.12 (6)(I) and the Penal Code, sec 37.10, to submit
a false statement to a government agency; and I consent to release of confidential information to the Texas Board of Nursing and further authorize
the Board to use and to release said information as needed for the evaluation and disposition of my application.

I understand that if I have any questions regarding this affidavit I should contact an attorney or the appropriate professional health provider. I will
immediately notify the Board if at any time after signing this affidavit I no longer meet the eligibility requirements.

Applicant’s Signature: Date: / /

Revised 12/2009
 TEXAS BOARD OF NURSING
333 Guadalupe - Suite 3-460, Austin, Texas 78701
(512) 305-7400

ENDORSEMENT APPLICATION INSTRUCTIONS FOR REGISTERED NURSES

Read all application instructions: To avoid a delay in the application process, please answer each question and follow
each of the instructions carefully. No application is complete until all required documentation and fees are received. An
incomplete application will delay approval for the temporary and permanent license.

Requirements for licensure in the State of Texas

1. Graduation from an approved school of professional nursing (general), of at least two academic years in length
which includes theoretical and clinical instructions in medical nursing, surgical nursing, obstetric nursing,
psychiatric nursing and nursing of children.

2. A satisfactory score in one of the following examinations:

State Board Test Pool Examination (SBTPE) - with a minimum score of 350; or,

National Council Licensure Examination for Registered Nurses (NCLEX-RN®)

3. Licensure from another jurisdiction which has requirements equivalent to Texas.

4. Must have been employed as a registered nurse or have taken and passed the appropriate RN examination during
the past four (4) years.

STOP: If you DO NOT MEET (1) through (4) of the above requirements, then you are NOT ELIGIBLE FOR
LICENSURE IN THE STATE OF TEXAS.

SECTION - A: (APPLICANT INFORMATION)

1. Write in black ink the information on the Endorsement Application. The application will be accepted only if
information is printed legibly.

2. Sign in the signature block area on page 1 and the Attestation/Consent to Release & Use of Confidential Records
statement on page 2.

3. Attach the required fee of $200.00 (check drawn on a US Bank, US Money Order or Canadian Postal Money
Order payable to the Texas Board of Nursing - DO NOT SEND CASH). The fee is non-refundable.

4. Criminal background checks are performed on all applicants for Licensure in Texas.

For applicants residing in Texas, L-1 Identity Solutions, [Link], offers Live Scan locations in Texas. In
order to be eligible for an electronic fingerprint submission, allow ten business days, after mailing the application
to the Board, to elapse before scheduling an appointment with L-1 Identity Solutions. You may schedule an
appointment online or by phone at 1-888-467-2080.

For applicants residing outside Texas, attach one (1) completed FBI fingerprint card. A fingerprint card can
be requested from our website at [Link]/olv/[Link]. Fingerprinting should be conducted
by a person who is appropriately trained to collect them. Your local law enforcement agency should be willing
to assist you.
5. Upon receipt of the completed paper application and fee, the Texas Board of Nursing will issue a one-time 120
day temporary license. To receive a permanent license, the applicant must do the following:

A. Complete the required criminal background check as directed in Step 4 of this section.

B. Provide a verification of license (VOL) from any and all U.S. states and territories where you hold or have
held a RN license. It is irrelevant if the license is inactive or delinquent in your former state(s) of licensure,
you still must provide the VOL. For internationally educated and licensed nurses, you must provide a VOL
from that country as well. Please see the instructions below for the VOL procedure.

C. All applicants by endorsement must pass the Texas nursing jurisprudence examination. You must pass this
examination prior to being issued a permanent license.

Instructions on taking the Texas nursing jurisprudence examination: After you are issued a temporary
license, you will be eligible to take the online nursing jurisprudence exam at [Link]/olv/[Link].
Follow the instructions to log on and complete the examination. The examination is based on the Texas
Nursing Practice Act (NPA) and the Texas Board of Nursing Rules and Regulations. We recommend that
you download a copy of the NPA and Board Rules and Regulations from our website by going to
[Link] and click on “Nursing Law and Rules”. You may also purchase a hard copy of the NPA
and Rules and Regulations by contacting the Texas Board of Nursing. The examination is a maximum of
two hours in length. If you are not successful in passing the examination, you may take the examination
again after seven working days has elapsed from the previous attempt. The cost of the examination is
included in your application fee. Again, you must pass this examination before the Texas Board of Nursing
will issue the permanent license.

SECTION - B: NURSE COMPACT DECLARATION

The Texas Board of Nursing entered into a Nurse Licensure Compact which allows nurses in Texas the privilege
of practicing in participating Compact states. As part of this process of initiating multi-state licensure, all
applicants for licensure in Texas must declare their primary state of residence and all states where you are
practicing or intend to practice in questions 9 & 10. For information on multi-state licensure, please read the
enclosed document titled “INFORMATION ABOUT THE NURSE LICENSURE COMPACT.

SECTION - C: ELIGIBILITY QUESTIONS

If you answer “YES” to one or more of the questions 13 - 17, you must attach a letter of explanation indicating
the circumstance(s) you are reporting to the Board of Nursing (BON). The document must be signed and dated.
If it is determined that the issue being reported to the BON meets the criteria for opening a case according to our
current rules, you will be required to pay a $150.00 review fee. Once we have a complete application, required
documents and the fee, if applicable, your file will be transferred to our Enforcement Department for review. This
review may take a minimum of three months. The BON will not approve an applicant for licensure or issue a
temporary license until a decision has been rendered by our Enforcement Department.

PROCEDURE FOR THE VERIFICATION OF LICENSURE (VOL) FORM(S) ARE AS FOLLOWS:

For the US state boards of nursing who participate in the national nursing database:

NURSYS LICENSURE VERIFICATION REQUEST FORM:

Please read the NURSYS License Verification Request Form Instructions: If you hold or have held
a license in any of the states that participate in NURSYS, you MUST go ONLINE at [Link]
to complete this process. You can view the list of NURSYS Licensure participating Boards on this
website.
TEXAS BOARD OF NURSING VERIFICATION OF LICENSURE FORM:

If you hold or have held a RN license in any other state/nursing jurisdiction(s), other than those listed on the
NURSYS form, you MUST submit the Texas Board of Nursing Verification of Licensure Form to that appropriate
state/nursing jurisdiction(s) for completion. If you will need to submit this form to multiple nursing boards/nursing
jurisdictions, you will need to copy the form and forward the form to those nursing boards/nursing jurisdictions.
Call the state/nursing jurisdiction to inquire about their verification procedure and required fee.

For Internationally licensed nurses: If you have a nursing license from a country other than the United States,
you must request a verification of licensure from that state, country, province or territory. Verification must come
directly from the licensing authority. We will also accept a license verification contained in a Credential Evaluation
Service (CES) Full Education course-by-course report from the Commission on Graduates of Foreign Nursing
Schools (CGFNS), the Educational Records Evaluation Service, Inc. (ERES) or the International Education
Research Foundation, Inc. (IERF). The verification of licensure must be contained in the CES and must have
been validated within one year of the date application for endorsement is filed with the Texas Board of Nursing.
You may access this service by going to one of the following websites: [Link], [Link] or
[Link].

IMPORTANT: Verification of licensure must be received from ALL states/provinces/territories and/or

countries to obtain permanent licensure in the State of Texas. We recommend that you
check with each nursing board regarding fees and/or other criteria.

The length of the application process for permanent license depends on how long it takes for all
states/provinces/territories and/or countries of licensure to submit the verification form(s) directly to the Texas Board of
Nursing and to receive results from the FBI/DPS check. This application is valid for one (1) year starting from the date
the application was received in our office, therefore the process must be completed within this time frame, or you will have
to re-apply and re-pay the required fee.

ADVANCED PRACTICE: If you plan to practice as a Nurse Practitioner, Nurse Midwife, Nurse Anesthetist or
Clinical Nurse Specialist, you must receive prior Board approval.
 Texas Board of Nursing
333 Guadalupe #3-460, Austin, Texas 78701

FAQs - Multistate Recognition - Nurse Licensure Compact

1. How and Why Did The Nurse Licensure Compact Begin?

The United States Congress passed the Telecommunications Act of 1996 in response to the rapidly
increasing practice of healthcare by electronic means. The Telecommunications Act called for
development of standards and an infrastructure for telecommunications in healthcare. The nursing
regulatory model in place at that time required a nurse to obtain licensure in each state where the nurse
wished to practice. In addition to the obvious bureaucratic constraints of this model, the Texas Board also
had no authority to take action against a nurse’s license if a patient in Texas was harmed by a nurse
practicing remotely in another state.

In response to the mandate of the Telecommunications Act, the National Council of State Boards of
Nursing (NCSBN) embarked on a 3-year journey to develop a model of Multistate nursing licensure
recognition that would "remove regulatory barriers to increase access to safe nursing care." The RN and
LPN/VN Nurse Licensure Compact began January 1, 2000, when it was passed into law by the first
participating states: Maryland, Texas, Utah and Wisconsin.

2. How Does This Multistate Licensure Model Work?

It is very similar to the driver’s license model. A person holding a driver’s license in his/her home state
is permitted to drive in other states without applying for a driver’s license in every state he/she drives
through. Though requirements for a driver’s license are similar across states, each state may determine
and vary its own licensure requirements. The Nurse Licensure Compact is similar in that it allows a nurse
licensed in one “home” compact state to practice in a party compact state without seeking an additional
nursing license. Another similarity to the driver’s license model is that the Nurse Licensure Compact is
implemented through laws passed by the legislature of each participating state. The essence of any state
Compact law must permit the nursing board of that state to recognize individuals licensed as nurses from
other participating compact states.

In order to enjoy the multistate licensure privilege, the Compact requires that the nurse be licensed in the
state in which he/she permanently resides. This license is known as a home state license. The nurse
must meet the licensure criteria of his/her home state in order to obtain and retain multistate licensure
recognition (MSR) privileges on his/her home state nursing license.

Other states belonging to the Nurse Licensure Compact are known as “Party” states because their state
governments have also agreed to recognize nurses licensed in other compact-member states. This
recognition allows a nurse to practice in a party state on his/her home state license. A nurse practicing
in another party state pursuant to the multistate privilege must comply with the state practice laws of the
state in which the patient is located at the time care is given.
3. What Happens If A Nurse Moves To Another State?

A nurse can hold a home state license in only one state at a time. If a nurse changes permanent
residence from one party state to another party state, then the nurse must relinquish licensure in the
previous state of residence and apply for licensure in the new home state. Rule 220.2©) permits a nurse
to practice on a home state license other than Texas for a maximum of 30 days when the nurse is
changing permanent residence. Under the Compact, the nurse may move back to his/her previous party
state and re-establish licensure or move to another party state and apply for licensure there.

If a nurse moves to a state that has not enacted or does not recognize the Compact, the previous home
state license converts to a Single-State license valid only in the former home state. A single-state nursing
license does not entitle the nurse to practice under multistate privilege in other party states.

4. What About Disciplinary Action Against A Nurse’s License?

The Compact is enforceable as law and cannot be changed without the consent of all party states. In
Texas, Chapter 304 of the Nursing Practice Act and Rule 220 establish the requirements regarding the
Nurse Licensure Compact.

A nurse practicing in a party state will be subject to the nursing practice laws and regulations of that
remote party state. The nurse must know and conform to the laws, rules and regulations affecting his/her
practice in the remote party state. If a nurse violates the Nursing Practice Act (NPA) or rules of the party
state, the nursing board of the party state may revoke or restrict the nurse’s privilege to practice in that
state, but cannot directly sanction the nurse’s home state license.

Violations of nursing practice occurring in a remote party state will be reported to the nurse’s home state
nursing board. The home state nursing board will then investigate and take appropriate disciplinary action
for a violation that occurred in a party state. Administrative procedures according to individual state law,
including due process rights of a nurse, will apply to disciplinary proceedings related to violations
occurring under a compact license privilege.

The shared goal of all US nursing boards is to protect public health and safety through the regulation and
monitoring of nursing education and practice. A coordinated licensure information system called NURSYS
promotes ongoing attainment of this goal through access to information on the licensing and disciplinary
history of each nurse. A party state must submit information on any current significant investigation,
action against a nurse’s compact privilege, or any denials of applications for licensure.

5. What is the impact of the Nurse Licensure Compact?

Mutual recognition of a nurse’s license in states belonging to the Compact increases nurse mobility and
facilitates delivery of health care by innovative communication practices such as telenursing. Additionally,
the Compact promotes the public health and safety by encouraging cooperative efforts among the party
states in nurse licensing and regulation. As more state legislatures enact the Nurse Licensure Compact,
the number of party states will increase and the nation will move closer to allowing one home state
license to grant a nursing privilege nationwide.

For questions regarding the Compact or its impact on your nursing license, contact BON staff at (512)
305-6809 or e-mail via webmaster@[Link]. General questions about the Compact language or
the concept of mutual recognition of licensure can be obtained from the National Council of State Boards
of Nursing website at [Link]
 TEXAS BOARD OF NURSING
333 Guadalupe, Ste. 3-460, Austin, Texas 78701

VERIFICATION OF REGISTERED NURSE LICENSURE FORM

I. APPLICANT
To be completed by the applicant and forwarded to original state/province of licensure and ALL appropriate licensing boards.
Name (Last, First, Middle, Maiden) Previous Name(s)

Current Address City State Zip

Date of Birth (mo/day/yr) Social Security Number Basic Nursing Education Program -Type of Basic Nursing Program

[ ] DIP [ ] ADN [ ] BSN [ ] OTHER

Name as appears on original license (Last,First,Middle,Maiden) City of Program State/Province Date of Completion

Original State of Licensure Issue date of Original Licensure Original License Number

II. LICENSING BOARDS: To be completed by licensing board(s) (other than original state/province of licensure) where you hold RN licensure and forward
(ENDORSEMENT) to the Texas Board of Nursing

This is to certify that __________________________________was issued RN license number _______________________ Date Issued____________________
(Applicant)

Current Licensure Status: [ ] Active [ ] Inactive [ ] Lapsed Expiration Date:_________________________

Has license ever been encumbered (denied, revoked, suspended, surrendered, limited, placed on probation)? **[ ] YES [ ] NO
** If yes, please send certified copies of Board actions.

III. ORIGINAL LICENSING BOARD: To be completed only by original state of licensure and forwarded to the Texas Board of Nursing
(EXAMINATION)

Basic Nursing Education Program Completed Approved by State/Province/Territory?

[ ] YES [ ] NO

Location (city/state/province) Graduation Date Type of Basic Nursing Program

[ ] DIP [ ] AND [ ] BSN [ ] Other____________________________

STATE BOARD TEST POOL EXAMINATION FOR REGISTERED NURSES NCLEX-RN® CNATSE

Medical Psychiatric Obstetric Surgical Nursing Comprehensive Exam Comprehensive Exam

Nursing Nursing Nursing Nursing of
Children

Score

Series/
Form#

Has license ever been encumbered (denied, revoked, suspended, surrendered, limited, placed on probation)? **[ ] YES [ ] NO
** If yes, please send certified copies of Board actions.

Licensing Board must affix seal and sign document below:

Signature:________________________________________________________________________

(SEAL)
Title: _________________________________________________________________________

State: _________________________________ Date:___________________________________