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Lbb Nursing

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LVN

Texas Board of Nursing
333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.texas.gov

For Office Use Only: Amount

Date Rec’d

Timely License Renewal Form
 This form may be used during the 60 days prior to the license expiration.  Please refer to the enclosed General Instructions, checklist and statistical code sheet to assist in completing this form.  Answer all questions, sign, date, and return both pages.  Processing time is within ten (10) business days once all requirements are met.  The Rules pertaining to the maintenance of your license and your eligibility to renew are located at 22 Texas Administrative Code (TAC) chapter 216 and §§213.27, 213.28, 213.29, 213.33, 217.6 and 217.7.

Make your check or money order payable to the Texas Board of Nursing. Fees are non-refundable. The application and payment are valid for one year from the date of receipt in the Board’s office and all licensure requirements must be met within that timeframe.

[ ] TIMELY LVN RENEWAL ONLY (prior to expiration date)

Fee: $45.00

[ ] LVN RETIRED LICENSE Fee: $10.00 Must be requested prior to license expiring and meet requirements of 22 TAC §217.9 [ ] LVN INACTIVE STATUS No Fee Required Must be requested prior to license expiring and meet requirements of 22 TAC §217.9

Name(Last):
Legal documentation is required for a name change (see 22 TAC §217.7)

(First): Social Security Number:
(City)

(M):
-

LVN License Number:
(Address)

Date of Birth:
Mo (State/Country)

/
Day

/
Yr (Zip/Postal Code)

** (
(E-Mail Address)

)

Business Fax Number

*For statistical information below, please use the statistical code sheet provided *Employment Status: *Primary Specialty: *Primary Practice Setting: *Highest Degree: *Primary Practice Position: *Primary Employment Zip:

In accordance with the Nursing

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