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Licensed Practical Nurse - Application Forms 


Profession Forms
Form # Title/Description
2193 WI ACT 146 - 72 Hour Practice Exception 
OLAS OLAS (Online Licensure Application System) WI Board of Nursing-approved schools 
   
Application by Examination, New Graduate 
Form # Title/Description
2252  Convictions and Pending Charges if applicable
739  Registered Nurse/Licensed Practical Nurse Licensure by Examination Application 
You must also register with NCLEX.
2434  Request For Initial Temporary Permit or Renewal of Temporary Permit For Registered Nurse or Licensed Practical Nurse
Can only be processed if complete application form #738 is received with all required fees
259  WI Board Approved Statement of Graduation or Completion For WI board approved schools only.
3049  Wisconsin Act 114 Certificate of Approval to take Examination 
741  Verification of Licensure For people licensed in another state or country. Use this form if your state(s) are not part of Nursys.
 
Application for People Licensed in Other States 
If you hold a license in a compact state, helpful information is available at www.ncsbn.org and Wis.Stat.Sec.441.50 (4)
Form # Title/Description
2252  Convictions and Pending Charges if applicable
772 Registered Nurse/Licensed Practical Nurse Licensure by Endorsement Application 
741  Verification of Licensure For people licensed in another state or country. Use this form if your state(s) are not part of Nursys.
 
Application for Examination Retake 
Form # Title/Description
1055  Nurse Retake Application For Licensure by Examination You must also re-register for this exam with NCLEX. 
 
Application for Re-registration
Form # Title/Description
2460 Application For Re-Registration of Registered Nurse/ Licensed Practical Nursing License 
2252  Convictions and Pending Charges if applicable
2766  Information For Completing Licensed Practical Nurse Re-Registration Application 
741  Verification of Licensure For people licensed in another state. Use this form if your state(s) are not part of Nursys

Other Information/Forms

Licensed Practical Nurse- License Information