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Education

Were you educated in US?

YesNo

Program Country :

Program :

Degree :

New School

School Name :
Address 1 :
Address 2 :
City :
State :
Zip:

If your program is not listed in the program dropdown, please do not continue the application. Call the board office at 1-800-656-5318 or email Licensing.exam@abn.alabama.gov.

Have you ever taken NCLEX for ?

YesNo

Select all states where you have applied for licensure :

List all dates when you took NCLEX examination for :

Format - MM/DD/YYYY

Test Date(s)

Date	State	Edit	Delete

Was your name on the last application

YesNo

Temporary Permit

By applying for a licensure by exam you will automatically be signed up for a temp license.

Yes

Name of the Employer :
Address :
City :
State :
Zip :

Temporary Permit Details

Name of Employee	Address	City	State	Zip	Edit	Delete

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eSignature

I affirm that the information recorded on this application concerning any and all items contained herein is true and correct. I understand that I may be required to submit documentation to support my affirmation. I further understand that any false statement is in violation of the Code of Alabama and the Alabama Board of Nursing Administrative Code and constitutes cause for disciplinary action up to and including denial of my application for licensure.