Get Border State License Recognition Report Of ... - Minnesota.gov - Mn

Completing the Border State License Recognition Report is essential for individuals seeking to practice nursing in Minnesota under the licensure privilege. This guide provides clear and concise instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete your Border State License Recognition Report.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your applicant information, including your last name, first name, maiden name, and any other last names. Ensure you provide your middle name or check the box for 'No middle name'.
3. Enter your contact details, including your phone numbers (home and business), street address, city, state/province, email address, postal code, and country.
4. Provide your birth date in the specified format (mm/dd/yyyy) and select your gender from the options provided.
5. Input your United States Social Security number as required by Minnesota Statute Sec. 270C.72, or indicate that you do not currently possess one and will notify the Board if you obtain it later.
6. Fill out the name of your school of nursing, graduation date, and type of program completed (RN or LPN). Additionally, provide the city, state, and country of your nursing school.
7. Answer the eligibility questions carefully. Provide an explanation for each 'Yes' response where applicable, especially regarding adverse actions or previous refusals of nursing licenses.
8. List the border state where you are currently licensed and provide the license type, along with the corresponding license number and expiration date.
9. Input the name and address of the health care facility where you are practicing, including the director of nursing's name, the institution type, and the start date.
10. Attach a copy of your current license from the border state and ensure your legal signature is present along with the date you filled out the form (mm/dd/yyyy).
11. Mail the completed form along with the nonrefundable fee of $50.00 to the Minnesota Board of Nursing. Ensure that you understand forms cannot be faxed or emailed.
12. Remember to submit this form and fee each time you change employment or renew your border state nursing license, and notify the Board of any changes to your license status.
13. Once you've finished, review your form for completeness, save changes, download, print, or share the document as necessary.

Start your application process online today and ensure your eligibility to practice nursing in Minnesota.