NOTE: The online applications will not currently work with Firefox. Please use Internet Explorer or Chrome. Also, make sure scripting is enabled.
Please note: Applications should be completed and submitted after the CRNP/CNM has met with the collaborating physician and completed a collaborative practice agreement. The agreement requires both signatures (CRNP and Physician) and is kept on file at the practice site. Sample agreements are available under the Advanced Practice Tab.
Applications are to be completed by the CRNP/CNM ONLY. As part of the on-line application the CRNP/CNM are required to complete regulatory questions and to personally attest to the accuracy of the answers. This can only be completed by the CRNP/CNM (no exceptions will be allowed). It is not acceptable for credentialing, office staff, or others to complete a collaborative practice application and may result in discipline of the nurse's license.