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LSBN Clinical Disclosure Form - Louisiana State Board of Nursing 2026
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- Click ‘Get Form’ to open the LSBN Clinical Disclosure Form in the editor.
- Begin by filling out your personal information in the 'Clinical Student Information' section. Include your name, address, phone number, date of birth, email address, and student number.
- In the 'Name and Type of Nursing Program' field, specify your nursing program details clearly.
- For the 'Reason for Disclosure', check all applicable boxes that pertain to your situation. Be thorough and honest in your disclosures.
- Sign and date the form at the bottom where indicated. Ensure that both you and your Dean/Director sign it as required.
- Attach any required documentation as specified in each disclosure category to support your claims.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.8 Satisfied (256 Votes) |
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lsbn board of nursing
FEES - A $20 application fee and Criminal Background Check fee of $42.50 (Total $62.50) in the form of a money order payable to LSBN. (Fees are non refundable).Read more
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