Name Change Form - Maryland Board of Nursing 2026

1. Click ‘Get Form’ to open the Name Change Form in our editor.
2. In Part I, enter your License/Certificate Number and Social Security Number. Fill in your email address, phone number, and current address including street, city, state, and zip code.
3. Move to Part II to indicate your name change. Enter your former name in the designated fields for last name and first/middle names. Then, provide your new name in the same format.
4. In Part III, check the appropriate box to indicate which documentation you are submitting with this form. Options include a marriage certificate, divorce decree, or court order.
5. Finally, sign and date the form at the bottom before submitting it through our platform.

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