The Application for Advanced Practice Nurse Certification is the form every nurse must file with the New Jersey Board of Nursing to be allowed to work as a nurse practitioner, clinical nurse specialist, or certified registered nurse anesthetist in New Jersey. State law under N.J.A.C. 13:37-7.1 says no one can practice, call themselves, or bill as an APN in New Jersey unless the Board has certified them first.
Getting this form right matters because a single missing transcript or an unnotarized signature can stall your start date for weeks while you wait on the mail. New Jersey now has almost 4,000 certified Advanced Practice Nurses across 17 recognized specialties, and the Board processes these packets in the order they arrive complete. This guide walks you through the current form, revision dated Rev. 1/2/19, line by line so your packet lands in the “complete” pile the first time.
Here is what you will learn:
- 📋 Exactly what each box on the APN application asks and the precise way to fill it in
- 💵 Every fee you owe, including the $100 filing fee and the later certification fee
- 📨 How to send your transcripts, national certification, and photo so the Board accepts them
- ⚠️ The field-level mistakes that trigger holds, denials, and costly delays
- ❓ Clear answers to the questions new and relocating APNs ask most
What the APN Certification Form Is and Who Must File It
The Application for Advanced Practice Nurse Certification is a state form issued by the New Jersey Board of Nursing, a unit inside the New Jersey Division of Consumer Affairs. The form turns a licensed registered nurse into a certified APN, which is the legal title New Jersey has used for nurse practitioners and clinical nurse specialists since November 1, 1999. The Board also certifies master’s-prepared certified registered nurse anesthetists under this same process.
The rule that requires the form is N.J.A.C. 13:37-7.1, part of Subchapter 7 of the Board’s regulations. In plain English, this rule says you must hold the Board’s certification before you act as an APN in any way. If you ignore this rule and practice without certification, you face discipline, fines, and possible action against your underlying RN license. For example, a new family nurse practitioner who starts seeing patients at an urgent care clinic the week she passes her boards, but before the Board certifies her, is practicing outside the law even though she is fully qualified. Many nurses wrongly believe that passing a national exam makes them an APN, but in New Jersey the title only becomes legal once the Board issues the certificate.
You must file this form if you are a registered nurse with a graduate degree who wants to practice in an advanced role. You must also file it if you are already certified or licensed as an APN in another state and you want to work in New Jersey. The one group that must not use this form is anyone who previously held APN certification in New Jersey, because those nurses use the separate APN Reinstatement application instead.
Before You Start: Documents and Information You Need
Gather everything below before you open the form, because the Board will not move your file forward until each piece arrives. Many items must be mailed directly to the Board by a school or agency, not by you, so start those requests early.
- Active New Jersey RN license number. You cannot hold APN certification without a current, valid New Jersey RN license, and the form asks for the number directly. If your RN license is inactive or expired, the Board denies the application.
- Graduate transcript. Your master’s or doctoral nursing program must mail the official transcript straight to the Board. A copy you carry in by hand does not count.
- National certification verification. Your certifying agency, such as the ANCC or AANP, must send proof of your specialty certification directly to the Board.
- Pharmacology proof. You need evidence of a graduate three-credit pharmacology course or 45 integrated hours, plus six contact hours related to controlled dangerous substances.
- Passport-style photograph. A 2-inch by 2-inch full-face photo taken within the past six months, signed on the back.
- Proof of citizenship or immigration status. A birth certificate, U.S. passport, naturalization certificate, or USCIS documents.
- Social Security number. Federal and state law require it, and leaving it blank causes an automatic denial.
- Fees. A $100 nonrefundable filing fee and a separate $18.75 fingerprint archive fee, both payable by check or money order.
- Name-change documents. A marriage license, divorce decree, or court order if your current name differs from your birth certificate.
- Out-of-state verification. A completed Verification Request Form sent to every other state where you have ever been licensed as an APN.
If any item is missing, the Board holds your file and mails you a deficiency letter, which adds weeks. The most common holdup is a transcript or certification that the applicant tries to submit personally instead of having the school or agency send it.
Where to Get the Form and How to Access It
You can download the official Application for Advanced Practice Nurse Certification as a PDF from the Board’s APN applications page. The same page also hosts an online APN Certification application option and the separate reinstatement form, so confirm you click the initial certification packet and not reinstatement. The PDF includes the instruction sheet, the application itself, the criminal history form, the pharmacology compliance form, and the out-of-state verification form, all in one file.
The Board mailing address printed at the top of the form is the New Jersey Board of Nursing, 124 Halsey Street, 6th Floor, P.O. Box 45010, Newark, New Jersey 07101. The Board’s phone number is 973-504-6430, and staff there can confirm which version of the form is current if you are unsure. Always pull a fresh copy from the website rather than reusing an old PDF, because fees and forms change.
When you open the PDF, print it on plain white paper and complete it in black ink, or type your answers before printing. The form says to print clearly and to answer all of the questions. Read the full instruction page first, because it lists the supporting documents you must arrange before you mail anything. Setting up your transcript and certification requests on day one is smart, since those outside parties control how fast your packet becomes complete.
Step-by-Step: How to Fill Out the APN Certification Application Line by Line
Work through the form in the order the boxes appear. Use your full legal name the same way on every page so nothing looks mismatched when the Board cross-checks your records.
Date Line at the Top
The form opens with a simple Date line above the personal information block.
This field asks for the day you sign and complete the application. Write the date using the month, day, and year, such as 06/15/2026. Use the date you actually finish the form in front of the notary, not the day you started filling it out. A common mistake is dating the form weeks before you visit the notary, which creates a gap that makes the affidavit look stale. Some applicants think the date here sets their certification start date, but it does not; the Board sets that based on when your file is complete and approved.
Date of Birth and Place of Birth
This field asks when and where you were born, listed as Date of birth with month, day, and year, and Place of birth with city and state.
Enter your birth date in month, day, year order, for example 03/14/1985, and your birth city and state, such as Trenton, NJ. If you were born outside the United States, write the city and country instead of a state. A common mistake is leaving place of birth blank because it feels minor, but the Board uses it to match your identity documents, and a blank slows verification. People often assume birth information is optional on a professional form, yet here it is part of the identity check that supports your background screening.
Box 1: Name
Box 1 asks for your full legal name, with a title option of Mr., Mrs., or Ms., then Last name, First name, Middle name, and Maiden name.
Write your name exactly as it appears on your RN license and your national certification. For example, Maria Lopez enters Lopez as last name, Maria as first name, and her middle name as printed on her records. If you have a maiden name that appears on your transcript or prior license, list it in the maiden name slot so the Board can connect those documents to you. A common mistake is entering a nickname or a shortened first name, which then fails to match your transcript and triggers a hold. Many filers think small spelling differences will not matter, but the Board cross-checks names against its records and your certifying agency, and any mismatch can stall the file.
Box 2: Address
Box 2 asks for your Home, Business, and Mailing addresses, each with street or P.O. Box, city, state, ZIP code, and county, plus a telephone number and e-mail.
Fill in a complete home address with street, city, state, ZIP, and county, and add your business and mailing addresses if they differ. For example, Marcus Bell lists his home street address as his address of record and his clinic as the business address. You may use a P.O. Box for the mailing line, but at least one address must include a full street, city, state, and ZIP code. A common mistake is listing only a P.O. Box everywhere, which the form does not allow and which delays processing. Note that the Division keeps your home address private unless you check the box consenting to release it, so provide a separate public address if you do not want your home disclosed under the Open Public Records Act.
Box 3: Social Security Number
Box 3 asks for your Social Security Number in the standard nine-digit format.
Write your full Social Security number in the spaces provided, for example 123-45-6789. You must provide it because state tax law, child support enforcement law, and federal law all require the Board to collect it. A common mistake is leaving this blank for privacy reasons, but the form states plainly that failure to provide it results in denial of certification. Some applicants fear the number will be shared widely, yet the law limits its use to tax administration, child support agencies, and adverse-action reporting to the national data banks.
Box 4: Citizenship / Immigration Status
Box 4 asks you to check one box for U.S. citizen, Alien lawfully admitted for permanent residence, or Other immigration status.
Check the single box that fits your status and attach the matching proof. A U.S.-born citizen like Maria Lopez checks U.S. citizen and attaches a copy of her birth certificate or passport, while a permanent resident attaches the front and back of her green card. A common mistake is checking a box but forgetting the supporting document, which stops the Board from confirming eligibility. People sometimes assume a Social Security card alone proves citizenship, but federal law requires the specific documents the form lists, so a card is not enough.
Box 5: Child Support Certification
Box 5 asks, under penalty of perjury, whether you have a child-support obligation, whether you are in arrears, whether the arrears match or exceed six months, and questions about court-ordered insurance, subpoenas, and arrest warrants.
Answer each Yes or No question honestly, then print your name, sign, and date the block. For example, a filer with no support order checks No across the board and signs. A common mistake is rushing past this block without signing, which voids the certification and forces a return. Under N.J.S.A. 2A:17-56.44d, a Yes to the arrears or warrant questions results in denial, and many applicants wrongly believe a current payment plan removes that bar, when only resolving the arrears clears it.
Box 6: Illegal Use of Controlled Dangerous Substances
Box 6 asks whether you are currently engaged in the illegal use of controlled dangerous substances, and if Yes, whether you are in a monitored rehabilitation program, followed by a signature and date.
Read the definition of “currently,” which means recently enough to affect your practice or within the previous 365 days, then answer truthfully and sign. Most applicants answer No and sign the block. A common mistake is skipping the signature line under this question, which leaves the response incomplete. The form notes you may assert the Fifth Amendment in writing if you have good cause, and some filers think any honest Yes guarantees denial, when the Board may still process your file, especially if you are in a monitored program.
Box 7: Name Change History
Box 7 asks Have you ever changed your name? with a Yes or No box.
Check Yes if you have ever legally changed your name, and attach a marriage certificate, divorce decree, or court order. For example, Janet Rivera, who married after earning her master’s degree, checks Yes and attaches her marriage certificate so her transcript name links to her current name. A common mistake is checking No while your transcript still shows a former name, which creates a document mismatch and a hold. People often think a name change is irrelevant once their license is updated, but the Board still needs the paper trail to connect every record to you.
Box 8: Other Professional Licenses Held
Box 8 asks whether you currently hold or have ever held any professional license or certificate in New Jersey or any other jurisdiction, with spaces for the type, number, state, and dates.
List every license you hold or have held, including your RN licenses in other states, with the number, issuing state, and dates. For example, a nurse moving from Texas lists her Texas RN license and Texas APRN license with their numbers and dates. A common mistake is listing only the New Jersey RN license and forgetting out-of-state credentials, which looks like a nondisclosure when the Board runs its checks. Some applicants think only nursing licenses count, but the box covers a professional license or certificate of any kind, so include other regulated credentials you have held.
Boxes 9 through 17: Disciplinary and Legal History
Boxes 9 through 17 ask a series of Yes or No questions about discipline, suspensions, agency actions, malpractice litigation, arrests, convictions, pending investigations, pending charges, and professional sanctions.
Answer each question carefully, and if any answer is Yes, attach a full written explanation and supporting documents on separate sheets. For example, a nurse who entered a pretrial intervention program years ago for a minor offense answers Yes to Box 13 and attaches the court records and an explanation. A common mistake is treating an expunged or old matter as if it never happened, but these questions reach back across your entire history, and an omission can be treated as a false statement that justifies denial. Many filers assume a dismissed charge needs no disclosure, yet Box 13 covers being summoned, arrested, or charged, so disclose and explain rather than hide it.
Box 18: Area of Clinical Specialty
Box 18 asks for your Area of Clinical Specialty.
Write the specialty that matches your education and national certification, such as Family Nurse Practitioner or Adult-Gerontology Clinical Nurse Specialist. The Board only recognizes certain APN categories, so use the title your certifying agency uses. A common mistake is writing a job description, like “ER nurse,” instead of a recognized specialty, which confuses the reviewer. Some applicants think they can list two specialties to broaden their scope, but you should enter the one tied to the certification you are submitting and apply separately for any additional category.
Box 19: New Jersey RN License Number
Box 19 asks for your New Jersey Registered Nurse license number.
Enter your active New Jersey RN license number exactly as it appears on your license. For example, Marcus Bell writes his current New Jersey RN number here. A common mistake is entering an RN number from another state, which fails the Board’s match since APN certification rides on a valid New Jersey RN license. Some applicants believe a pending New Jersey RN application is enough, but the form warns you must already hold an active, valid New Jersey RN license before you submit.
Box 20: Advanced Practice Status in Other States
Box 20 asks Are you certified or licensed for advanced nursing practice in another state? with a Yes or No box and a space to list the states.
Check Yes and list each state if you hold APN status elsewhere, then use the enclosed Verification Request Form for each one. For example, a nurse moving from Pennsylvania checks Yes, writes Pennsylvania, and sends the verification form to the Pennsylvania board. A common mistake is checking Yes but never sending the verification request, which leaves your file incomplete. Some applicants think New Jersey will pull these records automatically, but you must trigger the verification yourself through the other state’s board.
Box 21: Entry-Level Nursing Education
Box 21 asks for your Entry-Level Nursing Education, with checkboxes for Diploma, Associate Degree, or Baccalaureate Degree, plus the school name, graduation date, and credential.
Check the box for your first nursing degree and write the school, graduation date, and credential. For example, a nurse who began with a BSN checks Baccalaureate Degree and lists her university and graduation year. A common mistake is skipping this because it feels less important than the graduate degree, but the Board wants your full education path. There is also a line for entry-level CRNA education if your anesthesia training was not a master’s degree, so anesthesia applicants should complete that part.
Box 22: Graduate Nursing Education
Box 22 asks for your Graduate Nursing Education, including your Master’s Degree in Nursing area of specialty, graduation date, program name, and address, plus a Post-Master’s Certificate section.
Fill in your graduate program details and have the official transcript sent directly to the Board from the school. For example, Maria Lopez writes Family Nurse Practitioner as her area of specialty, her graduation date, and her university’s name and address. If you completed a post-master’s certificate to add your APN specialty, complete that section and have both the certificate transcript and your original master’s transcript sent. A common mistake is hand-delivering a transcript copy, which the Board rejects because it must come straight from the school. Some applicants think the program name on the form replaces the transcript, but the form is only the index; the official transcript is the proof.
Box 23: Pharmacology Education
Box 23 asks about your Pharmacology Education, including a graduate three-credit course, 30 hours of pharmacology with integrated hours noted, and six contact hours related to controlled dangerous substances.
Check and date the line that matches your training, and note the number of integrated hours if pharmacology was woven through several courses. For example, a nurse with a standalone graduate course writes that completion date, while one with integrated hours completes the enclosed Integrated Pharmacology Form. A common mistake is ignoring the six contact hours of controlled-substance pharmacology, which the Board requires and which is easy to overlook. If you finished your graduate pharmacology course more than five years before applying, you must add 30 contact hours of continuing pharmacology education, a step many repeat applicants forget.
Box 24: National Clinical Specialty Certification
Box 24 asks National Clinical Specialty Certification Yes or No, the name of the certifying agency, the examinations you passed, and the certification dates.
Check Yes, name your certifying agency such as the American Nurses Credentialing Center, and list the exam and your certification dates. Then have the certifying agency send verification directly to the Board. For example, an AANP-certified FNP writes the agency name, the exam, and her from-to certification dates. A common mistake is writing the dates but never requesting agency verification, leaving the file short one required document. If you have not yet passed your exam, the form has a section for the scheduled test date, but certification will not issue until the Board receives your passing verification.
The Affidavit and Notary Block
The Affidavit requires you to swear before a notary that you are the applicant and that all information is true, with your signature, the notary’s signature, the date, and the notary seal.
Do not sign the affidavit until you are in front of a notary public, then sign, and let the notary complete the state, county, date, name, signature, and seal. For example, Janet Rivera brings her finished form to a bank notary and signs only after the notary is ready to witness it. A common mistake is signing the affidavit at home, which makes the notarization invalid and forces you to redo the page. Some applicants think any witness will do, but only a commissioned notary public can complete this block, and the affidavit cites N.J.S.A. 45:11-23 and the Board’s rules that you agree to follow.
The Criminal History Background Check Form
The Certification and Authorization Form for a Criminal History Background Check asks for your name, address, date of birth, sex, Social Security number, whether you were fingerprinted by a New Jersey Division of Consumer Affairs board since November 2003, and any arrest or conviction history.
Complete every question, sign the certification, and include the $18.75 fingerprint archive fee if you have already been fingerprinted by the Division before. For example, a nurse fingerprinted for her New Jersey RN license checks Yes, names the board and the month and year, and encloses the $18.75 check. A common mistake is assuming you must be reprinted and waiting for an appointment, when a prior Division fingerprinting lets the Board pull the archive for $18.75. If you have never been fingerprinted by a Division board, check No, and the Board mails separate instructions with no payment needed yet.
Three Filled-Out Examples Using Real Scenarios
These three filers show how different applicants complete the same form. Each one follows a common path New Jersey APN applicants take.
Scenario 1: Maria, a new-graduate Family Nurse Practitioner certifying for the first time.
| Form Section | What Maria Enters |
|---|---|
| Box 1, Name | Lopez, Maria with middle name as printed on her license |
| Box 3, Social Security Number | Her full nine-digit number, no blanks |
| Box 4, Citizenship | Checks U.S. citizen, attaches birth certificate copy |
| Box 18, Clinical Specialty | Family Nurse Practitioner |
| Box 19, NJ RN License Number | Her active New Jersey RN number |
| Box 22, Graduate Education | Her MSN program, with transcript sent by the school |
| Box 24, National Certification | AANP, with agency verification mailed directly |
| Fees | $100 filing fee plus $18.75 fingerprint fee |
Scenario 2: Marcus, an experienced APN relocating from Texas.
| Form Section | What Marcus Enters |
|---|---|
| Box 8, Other Licenses | Lists his Texas RN and Texas APRN with numbers and dates |
| Box 19, NJ RN License Number | His new New Jersey RN number, obtained first |
| Box 20, Other-State APN Status | Checks Yes, writes Texas, sends Verification Request Form |
| Box 18, Clinical Specialty | Adult-Gerontology Acute Care NP |
| Box 22, Graduate Education | His MSN program, transcript sent directly |
| Box 23, Pharmacology | Graduate course plus six CDS contact hours |
| Box 24, National Certification | AACN, verification mailed to the Board |
| Fingerprint Form | Checks No, awaits separate fingerprinting instructions |
Scenario 3: Janet, a post-master’s certificate graduate with a name change.
| Form Section | What Janet Enters |
|---|---|
| Box 1, Name | Rivera, Janet, with maiden name listed |
| Box 7, Name Change | Checks Yes, attaches marriage certificate |
| Box 18, Clinical Specialty | Psychiatric-Mental Health NP |
| Box 22, Graduate Education | MSN plus post-master’s certificate, both transcripts sent |
| Box 23, Pharmacology | 30 added contact hours since MSN was over five years ago |
| Box 24, National Certification | ANCC, verification mailed directly |
| Affidavit | Signs only before the notary, who affixes the seal |
| Fees | $100 filing fee plus $18.75 fingerprint fee |
How to File the Completed APN Certification Application
New Jersey offers a downloadable paper packet and an online APN Certification application, both reached from the Board’s APN page. The paper packet is the most documented channel, so the steps below center on it, with notes on the online option.
For the paper packet, mail your completed, notarized application and the criminal history form to the New Jersey Board of Nursing, 124 Halsey Street, 6th Floor, P.O. Box 45010, Newark, New Jersey 07101. Enclose the $100 nonrefundable filing fee and the $18.75 fingerprint archive fee, each as a check or money order payable as the form directs, with the filing fee made out as instructed for the Board. Use a trackable mail service and keep your tracking receipt and copies of every page as your proof of filing. Processing depends on when your transcripts, certification, and verifications arrive, so the packet is not “received” in full until those outside documents land.
For the online application, you complete the same questions through the Board’s portal and pay the filing fee electronically, then mail the documents that must come from third parties, such as transcripts and certification verification. Whichever channel you choose, the Board still requires your school, certifying agency, and any other state boards to send their documents directly. After the Board reviews a complete file, you receive a letter telling you the initial certification fee due, which is either $80.00 or $160.00 depending on your RN license expiration date.
What Happens After You File
Once your packet arrives, the Board checks it for completeness and waits for the transcripts, national certification, and out-of-state verifications to come in from their sources. If something is missing, you get a deficiency letter, and your file pauses until you fix the gap. This is why mailing the third-party requests early is the single best way to speed things up.
When your file is complete and approved, the Board sends a letter stating the initial certification fee you owe, which is either $80.00 or $160.00 based on your RN license expiration date. After you pay that fee, the Board issues your APN certification, and you may then sign your credentials as R.N., A.P.N. Remember that certification alone does not let you prescribe; under N.J.A.C. 13:37-6.3 you must also have a joint protocol with a New Jersey-licensed collaborating physician before you write any prescription, and you will need CDS registration and DEA certification to prescribe controlled substances.
Mistakes to Avoid When Filling Out the Application
Each error below has stalled real applicants, and each one is simple to prevent.
- Signing the affidavit before seeing the notary. This voids the notarization and forces you to redo the page.
- Hand-delivering your own transcript. The Board rejects transcripts that do not come directly from the school, leaving your file incomplete.
- Forgetting to request national certification verification. Without the agency’s direct verification, the Board cannot confirm your specialty.
- Leaving the Social Security number blank. The form states this triggers an automatic denial of certification.
- Using a nickname in Box 1. A name that does not match your transcript and license creates a hold while the Board reconciles records.
- Skipping the six CDS contact hours in Box 23. This required pharmacology piece is easy to miss and stops prescriptive eligibility.
- Checking No on a name change while your transcript shows a former name. The mismatch flags a possible nondisclosure.
- Listing only a P.O. Box for every address. The form requires at least one full street address, so an all-P.O.-Box answer is returned.
- Omitting out-of-state licenses in Box 8. Missing credentials look like nondisclosure when the Board runs its checks.
- Forgetting the $18.75 fingerprint fee. A packet without the archive fee, when one is owed, sits until you pay.
- Not sending the Verification Request Form to other states. New Jersey will not pull those records for you, so your file stalls.
- Reusing an old PDF of the form. Fees and instructions change, so an outdated version can be rejected.
Do’s and Don’ts
These quick rules keep your packet clean and moving.
- Do pull a fresh copy of the form from the Board’s website, because fees and instructions change over time.
- Do arrange transcript, certification, and state verifications first, since outside parties set your timeline.
- Do sign the affidavit only in front of a notary, because an early signature invalidates it.
- Do use the exact name from your RN license and certification, so records match on the first review.
- Do keep copies of every page and your mailing receipt, because they are your proof of filing.
- Do answer every question, since the form requires complete responses to be processed.
- Don’t leave the Social Security number blank, because the form denies certification without it.
- Don’t hand-carry your transcript, since the Board only accepts it directly from the school.
- Don’t hide an old arrest or dismissed charge, because the disclosure questions reach across your whole history.
- Don’t assume New Jersey pulls your out-of-state records, since you must trigger each verification yourself.
- Don’t start practicing as an APN before the certificate issues, because that violates N.J.A.C. 13:37-7.1.
- Don’t forget the controlled-substance pharmacology hours, because they are required for your prescriptive path.
Pros and Cons of Filing on Your Own vs. With Help
Most APN applicants file on their own, but some use an employer’s credentialing team or an attorney for complicated histories.
| Filing on Your Own | Filing With Professional Help |
|---|---|
| Saves money, since you pay only the state fees | Costs extra for a service or attorney’s time |
| You control the timeline and follow up directly | A credentialing expert chases documents for you |
| Builds your own understanding of the rules | Eases stress when you have a complex legal history |
| Works well for a clean, straightforward file | Reduces errors on disclosure boxes 9 through 17 |
| No third party to coordinate with | Helpful when juggling out-of-state verifications |
The main reason to file alone is that the form is manageable for a new graduate with a clean record, and the savings are real. The main reason to get help is a complicated background, multiple state licenses, or a tight employer start date where a missed step is costly. A nurse with a past disciplinary action or pending charge often benefits from a professional who can frame the required explanations clearly.
FAQs
Do I need an active New Jersey RN license before I apply?
Yes. You must already hold a current, active, valid New Jersey RN license, and the form tells you not to submit the application until you do.
Do I write my maiden name in Box 1 if my transcript shows it?
Yes. List your maiden name in the maiden name slot of Box 1 so the Board can connect your transcript and prior records to your current name.
Do I have to give my Social Security number in Box 3?
Yes. State and federal law require it, and the form states that failing to provide it results in denial of your certification.
Do I sign the affidavit before going to the notary?
No. Sign the affidavit only in front of a notary public, because signing it early makes the notarization invalid and forces a redo.
Do I mail my own transcript to the Board?
No. Your graduate program must send the official transcript directly to the Board, since a copy you deliver yourself is not accepted.
Do I check Yes in Box 20 if I am certified in another state?
Yes. Check Yes, list each state, and send the enclosed Verification Request Form to every other board where you hold or held APN status.
Do I owe more than the $100 filing fee?
Yes. Beyond the $100 nonrefundable filing fee, you pay an $18.75 fingerprint fee and a later certification fee of either $80.00 or $160.00.
Do I need to be fingerprinted again for this application?
No. If a New Jersey Division of Consumer Affairs board fingerprinted you since November 2003, the Board pulls the archive for an $18.75 fee.
Do I disclose a dismissed or old arrest in Boxes 13 and 14?
Yes. These questions reach across your entire history, so disclose and explain rather than risk an omission that can justify denial.
Do I list my out-of-state RN license in Box 8?
Yes. Box 8 covers any professional license of any kind in any jurisdiction, so include your out-of-state RN and APRN credentials with numbers and dates.
Do I need extra pharmacology hours if I graduated long ago?
Yes. If your graduate pharmacology course was more than five years before applying, add 30 contact hours of continuing pharmacology education.
Do I file this form to renew or reinstate an APN certification?
No. This form is for initial certification, and nurses who previously held New Jersey APN certification must use the separate APN Reinstatement application.
Do I get prescriptive authority the moment I am certified?
No. You must also have a joint protocol with a New Jersey-licensed collaborating physician, plus CDS and DEA registration, before prescribing.
Do I have to answer the controlled-substance question in Box 6?
No. You may assert the Fifth Amendment in writing if you have good cause, though you must still complete every other question on the form.
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