Arizona State Board of Nursing
1740 W Adams Street, Suite 2000
Phoenix, AZ 85007
Phone (602) 771-7800
Website: www.azbn.gov
Joey Ridenour
Executive Director
Doug Ducey
Governor
To: Refresher Course Participants
From: Robert Ellis, BSIT, MBA, MPM, Associate Director – Operations & Licensing
Re: Obtaining a Temporary License for Refresher Course Only
Refresher candidates who do not hold an active Arizona license and are seeking a temporary license must obtain a
temporary license “For Refresher Course Only” before attending clinicals.
1. Please submit one of the following applications:
a) A renewal application if you have previously been licensed in Arizona.
b) An endorsement application if you have been licensed in another state and are applying for licensure in Arizona
c) An examination application if you have never been licensed as a nurse. Applicants must pass NCLEX before a
temporary license can be issued. Please note that some refresher courses do not take refresher candidates for
NCLEX review.
2. A Temporary License request form stating “Refresher Course Only”. The License will be issued for 6 months. It
cannot be used for any other employment purpose.
3. Submit a copy of the invoice showing you paid for a refresher course, (full or partial payment).
4. You must have passed NCLEX/SBTPE.
5. If you are a graduate of a foreign nursing program:
a) Has submitted a copy of a letter from CGFNS/IERF/ERES/Joseph Silney with ID number-endorsement
applicant only
b) Have met the English Language requirement. (Must be met prior to taking NCLEX exam)
For more information regarding Requirements for Applicants Educated in a Foreign Country visit
www.azbn.gov/ForeignEducatedRequirements.aspx.. Submit documentation that shows evidence of legal status in
the United States. See List A & B showing acceptable documentation at www.azbn.gov/Citizenship.aspx. The
Cover Sheet must be attached to documentation showing evidence of lawful presence if submitted separately from
the application.
6. Submit documentation that shows evidence of legal status in the United States. See List A & B showing acceptable
documentation at www.azbn.gov/Citizenship.aspx. The Cover Sheet must be attached to documentation showing
evidence of lawful presence if submitted separately from the application.
7. Pay
the appropriate fees:
Renewal Applicant Endorsement Applicant Exam Applicant
Renewal $160 Endorsement $150 Exam $300
Temporary $0 Fingerprint $50 Fingerprint $50
Temporary $0 Temporary $0
Total Fee $160 Total Fee $200 Total Fee $350
There is no fee for a temporary license for “Refresher Course Only” if you meet one of the following criteria:
On probation with the Board
Have not been licensed as an RN or LPN within 2 years of graduating from a nursing program
Has not met the practice requirement of 960 hours within 5 years prior to submitting application
License reinstated after revocation and a refresher course is required.
All applications can be printed from the Arizona State Board of Nursing website at www.azbn.gov/Applications.aspx
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3
4.
5.
a)
b)
TEMPRCOA
SIGNATURE - REQUIRED
Date
Applicant's Legal Last Name
Social Security Number
State/Province
City
Street Address
1. Citizenship documentation is required for applicants (documents must be included with your application).
2. Have submitted application and fees for full licensure/certification.
Phone Number
Applying by
Endorsement Examination Renewal
Credential applying for
RN
If a graduate of a foreign nursing program:
has submitted a copy of a letter from CGFNS/IERF/ERES/Joseph Silny with ID number;
has met English language requirement
You are eligible for a temporary license/certificate if you meet
the following requirements below for your application type.
REFRESHER COURSE APPLICANTS $0 fee for temporary license.
Office Use Only
Start date of Refresher Course
Have submitted copy of enrollment in an Arizona Board approved refresher course/copy of invoice showing full or partial
payment to refresher program or submitted a letter from the clinical perceptor for AP nurses.
Have passed NCLEX/SBTPE
LPN AP
Applicant's Legal First Name
REQUEST FOR TEMPORARY CERTIFICATE/
LICENSE FOR: Refresher Course Only
This Request must either accompany an exam/endorsement
/renewal application or an application must already be on file.
Zip Code