The Board of Nurse Examiners and Declaratory Orders |
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Each applicant to a school of nursing is required to answer these questions re Declaratory Orders. If an applicant or student has situations that fall under Declaratory Orders, then the student is urged to address this early rather than wait until near application for NCLEX.
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In
reference to Declaratory Orders
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TEXAS BOARD OF NURSING PO BOX 430 AUSTIN, TEXAS 78767-0430 |
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The following statements (1-6) have been revised effective July 2002. After you have read the information, sign and detach the bottom portion and return it to (your faculty member). |
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| The Texasd Board of Nursing has identified certain circumstances that may render a potential candidate ineligible for licensure as a registered nurse in the State of Texas. The Board provides individuals the opportunity to petition for a Declaratory Order as to their eligibility in accordance with Article 301.257 of the Nursing Practice Act. (Deferred order, prosecution, or adjudication--a determination by a court that is withheld or delayed for a specific time period.) | ||||
| If you are required to answer "YES" to any of the following questions, you must request a Declaratory Order Petition. | ||||
| 1. | Have you ever been denied licensure by any licensing/certifying agency in any state, country or province? | |||
| 2. | Have you ever had disciplinary action taken against you by any licensing/certifying agency in any state, country or province? | |||
| 3. | Have you ever been convicted of a crime or received a deferred order, with or without an adjudication of guilt, for felony or misdemeanor offense other than a minor traffic violation? | |||
| 4. | Have you been diagnosed, treated or hospitalized in the past five (5) years for schizophrenia or other psychotic disorders, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder. (You may answer "NO" if you have completed and/or in compliance with TPAPN for mental illness.) | |||
| 5. | Have you been addicted or treated for the use of alcohol or any drug within the past five (5) years? ((You may answer "NO" if you have completed and/or in compliance with TPAPN for substance abuse.) | |||
| 6. | Have you been issued any order concerning your eligibility for examination or licensure by the Board of have you ever received a proposal of ineligibility from the Board? | |||
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----------------------------------------------Detach
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| I have been given a copy of the circumstances that may render a potential candidate ineligible for licensure as an RN in Texas (effective 2002). | ||||
| PLEASE PRINT NAME | ||||
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NAME:
_______________________________________________________________
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FIRST
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MIDDLE
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MAIDEN
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LAST
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SOCIAL SECURITY #
_______________________
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DATE OF BIRTH
_______________
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__________________________________
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________________
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SIGNATURE
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DATE
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For a complete review of the form the applicant must complete, go to this page and follow the links under Candidate Licensure. |
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01/2005