Fillable Online Application for Licensure as a Clinical 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and Delaware license number in the designated fields. Ensure accuracy as this information is crucial for verification.
3. Fill in the collaborator's name, business/practice name, and location address. Remember to provide a physical address; PO Boxes are not accepted.
4. Input the collaborator's phone number and email address to facilitate communication.
5. Select your professional licensure type and enter the corresponding license number and specialty.
6. Indicate the type of business/practice where the collaborative agreement occurred by checking all applicable options.
7. Choose the APRN role you collaborated with and specify the population focus area if applicable.
8. Document total hours of APRN clinical practice along with the time period during which you served as a collaborator.
9. Finally, verify competency by selecting 'Yes' or 'No' and provide your signature along with the date to complete the form.

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