State Board Requirements - Excelsior College 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information in the 'APPLICANT/STUDENT INFORMATION' section. Include your name, email, address, and phone number.
3. In the 'APPLICANT/STUDENT WORK EXPERIENCE' section, specify your current position and organization. Select your credential type from the options provided: LPN/LVN, Paramedic, or Military.
4. Indicate the hours worked in your nursing-related role within the past year. Provide a detailed description of the patient care you deliver.
5. Sign and date the form in the 'APPLICANT/STUDENT SIGNATURE' section to confirm that all information is accurate and that you meet program requirements.
6. Ensure your supervisor completes their section by signing and providing their credentials, confirming your employment and experience.

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