Application to Apply Military Service to an Experience or Educational Requirement for Licensure - Iowa

The Iowa Board of Nursing has released this version of the "Application to Apply Military Service to an Experience or Educational Requirement for Licensure" on April 1, 2018.

This form may be used by all Iowa residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Iowa Board of Nursing
400 SW 8th Street, Suite B
Des Moines, IA 50309-4685
Telephone: 515.326.4400
Fax: 515.281.4825
E-Mail: jimmy.reyes@iowa.gov
APPLICATION TO APPLY MILITARY SERVICE TO AN EXPERIENCE
OR EDUCATIONAL REQUIREMENT FOR LICENSURE
This form may be used to request credit toward an experience or educational requirement for licensure based
on military education, training, or service obtained or completed in military service. Credit for military service
may not be applied to an examination requirement. “Military service” means honorably serving on federal
active duty, state active duty, or National Guard duty, as defined in Iowa Code section 29A.1, in the military
services of other states, as provided in 10 U.S.C. section 101(c), or the organized reserves of the United
States, as provided in 10 U.S.C. section 10101. You may mail, hand deliver, fax or email a completed form.
There is no fee for this application.
Name:
Address:
Phone:
City, State
Email:
Zip Code
Please check the license to which your application applies:
Licensed Practical Nurse
Registered Nurse
Advanced Registered Nurse Practitioner
What is the experience or education obtained to which your application applies?
Please identify the military education, training, or service you believe satisfies all or part of this requirement,
and attach documents, military transcripts, diploma, a certified affidavit, or forms that verify completion of the
relevant military education, training, or service, which may include, when applicable, the applicant’s Certificate
of Release or Discharge from Active Duty (DD Form 214) or Verification of Military Experience and Training
(VMET) (DD Form 2586).
Signature
Date
Rev 4/18
Iowa Board of Nursing
400 SW 8th Street, Suite B
Des Moines, IA 50309-4685
Telephone: 515.326.4400
Fax: 515.281.4825
E-Mail: jimmy.reyes@iowa.gov
APPLICATION TO APPLY MILITARY SERVICE TO AN EXPERIENCE
OR EDUCATIONAL REQUIREMENT FOR LICENSURE
This form may be used to request credit toward an experience or educational requirement for licensure based
on military education, training, or service obtained or completed in military service. Credit for military service
may not be applied to an examination requirement. “Military service” means honorably serving on federal
active duty, state active duty, or National Guard duty, as defined in Iowa Code section 29A.1, in the military
services of other states, as provided in 10 U.S.C. section 101(c), or the organized reserves of the United
States, as provided in 10 U.S.C. section 10101. You may mail, hand deliver, fax or email a completed form.
There is no fee for this application.
Name:
Address:
Phone:
City, State
Email:
Zip Code
Please check the license to which your application applies:
Licensed Practical Nurse
Registered Nurse
Advanced Registered Nurse Practitioner
What is the experience or education obtained to which your application applies?
Please identify the military education, training, or service you believe satisfies all or part of this requirement,
and attach documents, military transcripts, diploma, a certified affidavit, or forms that verify completion of the
relevant military education, training, or service, which may include, when applicable, the applicant’s Certificate
of Release or Discharge from Active Duty (DD Form 214) or Verification of Military Experience and Training
(VMET) (DD Form 2586).
Signature
Date
Rev 4/18

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