Name Change

Name Change Request Form

Email the completed form, a copy of the legal document that makes your name change effective, examples: marriage license, divorce decree to the Board of Nursing office. Upon receipt, your name will be changed on your registration record. 

Until your licensure record is updated, continue to use your former name in relation to your practice as a CNA or Registered Medication Aide.
Page Updated: 9/24/2024 11:59:58 AM