Fillable Nursing Felony Convictions (Indian Hills Community College)

Fill Online, Printable, Fillable, Blank Nursing Felony Convictions (Indian Hills Community College) Form

Use Fill to complete blank online INDIAN HILLS COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Nursing Felony Convictions (Indian Hills Community College)

On average this form takes 3 minutes to complete

The Nursing Felony Convictions (Indian Hills Community College) form is 2 pages long and contains:

  • 2 signatures
  • 0 check-boxes
  • 5 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Indian Hills Community College

BROWSE INDIAN HILLS COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Felony Convictions
Nursing Program
Iowa Board of Nursing
RiverPoint Business Park
400 S.W. 8th Street Suite B
Des Moines, IA 50309-4685
The Board of Nursing has express authority to review the felony conviction of an applicant and may deny licensure
to any applicant who has been convicted of a felony, which relates to the practice of nursing. An applicant is a
person who has filed an application with the Board and who possesses all of the statutory requirements for the
granting of a license. Persons who have not yet completed the prerequisites for filing an application, such as
completion of a course of study approved by the Board, are not applicants.
The Board has a statutory authority to review the felony conviction of a student of nursing who has neither
completed the nursing program approved by the Board nor filed an application with the Board.
Board sta is not authorized to preliminarily review the felony conviction and provide information regarding
action the Board might take upon application.
I have read and fully understand the above policy. I fully understand that should I have a felony record, I may
be denied licensure by the State Board of Nursing and with this understanding, I recognize that the decision to
continue with my nursing education is mine alone, regardless of the final outcome.
Name:
Signature: Date:
This form with the student’s signature is required at the beginning of the nursing program and will be placed in
the student’s personal file.
click to sign
signature
click to edit
Iowa Board of Nursing
RiverPoint Business Park
400 S.W. 8th Street Suite B
Des Moines, IA 50309-4685
Previous conviction of a felony does not automatically bar an individual from eligibility for licensure.
Iowa Code 174.3 Qualifications states:
An applicant for a license to practice a profession under this title is not ineligible because of age,
citizenship, sex, race, religion, marital status or national origin, although the application form may require
citizenship information. Any board may consider the past felony record of an applicant only if the felony
conviction relates directly to the practice of…nursing…for which the applicant requests a license. Character
references may be required, but shall not be obtained from licensed members of the profession.
The members of the Iowa Board of Nursing will determine if the felony relates directly to the practice of nursing.
In order to prepare your credentials to be submitted to the Iowa Board of Nursing, we must have the following
materials:
1. Copy of the indictment or charge that was brought against you. Please request that the court in which the
proceedings were held forward a copy to the oce of the Iowa Board of Nursing.
2. Copy of the order of sentencing that was signed by the judge.
3. The name and address of your probation ocer.
After receipt of the above information, your materials will be presented to the Board for review at their next
regularly scheduled meeting.
Signature:
Address:
Telephone:
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Nursing Felony Convictions (Indian Hills Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document