Instructions on Utilizing New Mexico Board Of Nursing
Now that you have the New Mexico Board of Nursing form in front of you, it’s important to fill it out accurately and completely. Follow these steps to ensure that your attestation is properly filled and submitted on time.
- Write the current date at the top of the form:
- Fill in the blank space for the day.
- Fill in the blank for the month.
- Fill in the year.
- Print your name in the designated area:
- Clearly write your full name.
- Provide your birth date:
- Fill in your birth date in the blank provided.
- Explain why your license/certificate expired or lapsed:
- Write your explanation in the space provided. Be clear and concise.
- If you need more space, attach additional documents as necessary.
- Answer one of the questions a or b:
- If you did NOT work at all, check the box next to option A and initial.
- If you DID work on an expired/lapsed license, check option B, and then complete the additional fields:
- Write your supervisor's name.
- Provide your supervisor's telephone number.
- Write your supervisor's email address.
- Indicate the number of days/shifts worked since your license expired or lapsed.
- Attach a list or payroll records of all shifts worked and ensure your supervisor signs this document.
- Initial to confirm completion of this section.
- Understand and agree to the terms:
- Carefully read the statement about returning the attestation and initial to confirm your understanding.
- Certify your information as true:
- Sign your name in the space provided.
- Print your name again below your signature.
- Fill in today’s date again.
- Submit the completed form:
- Ensure you send the form to the New Mexico Board of Nursing within 5 business days of your renewal application.