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How to Notify the Arkansas State Board of Nursing of a Name Change Form 2012

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Receive a replacement license, but your name change will be on file with ASBN. This is to certify that my name has been legally changed from: FIRST to MIDDLE FIRST due to MAIDEN LAST MIDDLE Marriage Divorce LAST Religious Order Such as recorded in County, State of Social Security Number Telephone Number ( License Number Date of Birth Current Address Other CITY MM/DD/YYYY ZIP Legal Document Submitted (check one) check type of license(s) Declaration of primary state of...

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What is the How To Notify The Arkansas State Board Of Nursing Of A Name Change Form

The form to notify the Arkansas State Board of Nursing of a name change is an official document used by licensed nurses in Arkansas to update their personal information with the board. This form is essential for maintaining accurate records and ensuring that all communications and certifications are aligned with the nurse's current legal name. It is crucial for compliance with state regulations and for the integrity of the nursing profession.

How to use the How To Notify The Arkansas State Board Of Nursing Of A Name Change Form

Using the form involves several simple steps. First, you need to obtain the official name change form from the Arkansas State Board of Nursing's website or office. Once you have the form, fill it out completely, providing your previous name, new name, and any required identification details. After completing the form, submit it according to the instructions provided, ensuring that all information is accurate to avoid delays in processing.

Steps to complete the How To Notify The Arkansas State Board Of Nursing Of A Name Change Form

Completing the name change form involves the following steps:

  • Download the form from the Arkansas State Board of Nursing website.
  • Fill in your previous name and new name accurately.
  • Provide any additional required information, such as your license number.
  • Sign and date the form to certify that the information is correct.
  • Submit the form via mail, in person, or electronically if allowed.

Legal use of the How To Notify The Arkansas State Board Of Nursing Of A Name Change Form

This form is legally binding and must be filled out accurately to ensure compliance with Arkansas nursing regulations. Failure to notify the board of a name change can lead to complications in licensing and may affect your ability to practice legally. It is important to keep your records up to date to avoid any legal issues or misunderstandings regarding your professional status.

State-specific rules for the How To Notify The Arkansas State Board Of Nursing Of A Name Change Form

Arkansas has specific rules regarding the notification of name changes for licensed nurses. These rules include the requirement to submit the name change form within a specified timeframe after the legal name change occurs. Additionally, the board may require supporting documentation, such as a marriage certificate or court order, to verify the name change. Familiarizing yourself with these state-specific rules ensures compliance and smooth processing of your request.

Required Documents

When submitting the name change form, you may need to provide certain documents to validate your name change. Commonly required documents include:

  • A copy of your marriage certificate if the name change is due to marriage.
  • A court order if the name change is legally mandated.
  • Identification that reflects your new name, such as a driver's license or state ID.

Form Submission Methods (Online / Mail / In-Person)

The name change form can typically be submitted through various methods. Depending on the Arkansas State Board of Nursing's current policies, you may have the option to:

  • Submit the form online through the board's official website.
  • Mail the completed form to the designated address provided by the board.
  • Deliver the form in person to the board's office during business hours.

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067.00.18 Ark. Code R. 003 - Rules, Chapter 3

The Arkansas State Board of Nursing authorizes the registered nurse ... Board, shall immediately notify the Board in writing of the change. Notes.Read more

Arkansas State Board of Nursing

Written comments should be submitted to the Director, Arkansas State Board of Nursing, 1123 South University Ave., Suite 800, Little Rock, AR 72204; no later ...Read more

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To notify the Arkansas State Board of Nursing of a name change, you need to complete the designated name change form and submit it along with any required documentation. Using airSlate SignNow can simplify this process by allowing you to eSign and send the form directly to the Board. This ensures your request is processed quickly and efficiently.

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While airSlate SignNow offers a cost-effective solution for eSigning and document management, the fees associated with notifying the Arkansas State Board of Nursing of a name change form may vary based on the Board's requirements. It’s best to check with the Board directly for any applicable fees for processing your name change request.

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