Kansas Nursing Newsletter - January 2015

Page 12 • Kansas Nursing Newsletter January, February, March 2015
ADDRESS CHANGE
You can use your user ID and password to change your address on-line OR send us the
change of address in writing. Please submit within 30 days of address change. You may
mail your address change to Kansas State Board of Nursing; 900 SW Jackson St, Ste 1051;
Topeka, KS 66612-1230. The Address Change form is available at www.ksbn.org/forms.
If you do not have access to a computer please include the following information in your written
request:
First and Last Name
(please print complete names)
______________________________________________________________________________________
Kansas Nursing License Number(s)
______________________________________________________________________________________
Social Security Number _______________________________________________________________
Old Address and New Address
(complete Street Address with Apt #, City, State, and Zip)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Southwestern College is accredited by the Higher Learning
Commission and the Commission on Collegiate Nursing
Education, One Dupont Circle, NW, Suite 530,
Washington, DC 20036, phone 202-887-6791
http://www.aacn.nche.edu/ccne-accreditation.
______________________________________________________________________________________
Home phone number and Work Phone number
______________________________________________________________________________________
Date the New Address is in Effect
______________________________________________________________________________________
Sign and date your request
______________________________________________________________________________________
We are unable to accept your request to change your address from information delivered
over the phone or via an email. All requests must be received in writing and include a
signature.
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