Arkansas nurses may need to update their legal name due to marriage, divorce, or a court order issued by a circuit court. The Arkansas State Board of Nursing (ASBN) requires a completed name change petition along with supporting documents such as a marriage certificate, a divorce decree, or a court order signed by a judge. The petition must list your current license number and the newly changed name.
Filing costs $30 per affected nursing credential. Accepted payment methods include:
No new credential is issued. The change is entered into your ASBN case file and all official records are updated. Per the Nurse Licensure Compact, indicate your primary state of residence on the filing.
Nurses holding both an RN and LPTN must file a separate petition and pay the fee for each credential affected. Falsification of information can lead to disciplinary action. All supporting documents must be originals or certified copies. Mail your completed petition and payment to the ASBN in Little Rock, Arkansas. For related documents, see the petition for name change, the divorce decree, or the court name change process.
| Question | Answer |
|---|---|
| Form Name | Arkansas Name Change Request Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Name Change Request Form how to notify the arkansas state board of nursing of a name change form |