Finger Print Card Order Form

KANSAS STATE BOARD OF NURSING

LANDON STATE OFFICE BUILDING

900 SW JACKSON, SUITE 1051

TOPEKA, KS 66612-1230

FINGER PRINT CARD

ORDER FORM

Name and complete address required to mail out a card, all incomplete submissions will be discarded. The telephone number and email address are optional and only used if we need to contact you about the finger print card order.

Name
Street Address
City
State
Zip Code
Telephone
E-Mail Address

Attestation
I realize that this application is a legal document and by pressing the Submit button you are declaring under penalty of perjury under the laws of the State of Kansas that the information I have provided is true and correct to the best of my knowledge.
If all the above information is correct please press the Submit button .
Otherwise please go back and correct any information that is necessary.