LIVE SCAN FORM - Use this method if residing in California. Before submitting your request for a Live Scan form, you must first submit your application for RN licensure by Examination or Endorsement. If we receive your request without an active application on file, you will not receive a Live Scan form (applies to initial Examination and Endorsement applicants only).
Live Scan Form
FINGERPRINT CARD - Use this method if residing outside of California
Fingerprint Card - (1 card per applicant only)
(*) Denotes Required Field
Last Name*:
First Name*:
RN License, File, or Entity Number*:
Email Address*:
Please complete the fields below ONLY if requesting a fingerprint card. Be sure that you enter your information correctly before clicking the "Submit" button as this will be used to generate a mailing label.
Address *:
Apartment or Suite Number:
City *:
State or Province:
Country (if other than US):
Postal / Zip Code*:
