Blank Arkansas Name Change Request Form

When filling out and using the Arkansas Name Change Request form, it is essential to understand the following key points:

• Legal Name Change: Ensure that the name you are requesting to change is legally recognized, whether due to marriage, divorce, or another reason.
• No Replacement License: Be aware that you will not receive a new license after submitting the name change request. The change will be documented on file with the Arkansas State Board of Nursing (ASBN).
• Fee Structure: There is no fee for the name change request itself, but changing the name on your nursing license incurs a fee of $30.00 for each license.
• Documentation Required: Attach a copy of the legal document that supports your name change, such as a marriage license, divorce decree, or court order.
• Contact Information: Provide accurate contact details, including your phone number and email address, to ensure ASBN can reach you if needed.
• Primary State of Residence: You must declare your primary state of residence, which is important for compliance with the Nurse Licensure Compact.
• Signature Requirement: Your signature is necessary on the form, confirming that the information provided is accurate and truthful.
• Payment Method: If you are paying for a license change, specify your payment method. Options include personal checks, money orders, or credit cards.
• Processing Fees: Be mindful of additional processing fees when using a credit card for payments, which are separate from the license fees.
• Nonrefundable Fees: Understand that all fees associated with the name change request are nonrefundable, so ensure all information is correct before submission.

Completing the Arkansas Name Change Request form can be straightforward, but many individuals make common mistakes that can delay the process. One frequent error is failing to provide all necessary personal information. It's crucial to fill out your full name, including any middle names or maiden names, as listed on official documents. Omitting any part of your name can lead to confusion and potential rejection of your application.

Another common mistake is neglecting to check the appropriate type of license for the name change request. Applicants should clearly indicate whether they are requesting a name change for their RN, LPN, LPTN, or RNP license. Failing to specify the correct license can result in processing delays.

People often forget to attach the required legal documentation that supports the name change. Whether it’s a marriage license, divorce decree, or court action, submitting the correct documents is essential. Applications submitted without these attachments may be returned, causing unnecessary delays.

Additionally, many applicants overlook the signature requirement. The form must be signed and dated by the applicant. A missing signature can lead to the rejection of the request, so it’s important to double-check this detail before submission.

Incorrect payment methods also pose a problem. Some individuals mistakenly believe that the name change request is free, while others fail to provide the correct payment information for replacement licenses. It’s important to review the payment options and ensure that all fees are included as specified in the instructions.

Another issue arises when applicants do not provide their current contact information. Including an up-to-date telephone number and email address is vital for communication regarding the application status. Missing this information can hinder timely updates.

Some people may also misinterpret the declaration of primary state of residence. This section is crucial for those participating in the Nurse Licensure Compact. It’s essential to accurately declare the primary state of residence to avoid complications with licensing.

In addition, applicants sometimes fail to verify the accuracy of the information provided. Simple typographical errors can lead to significant issues. Carefully reviewing the entire form before submission can prevent these mistakes.

Lastly, applicants may not be aware of the nonrefundable nature of the fees. Understanding that the fees paid cannot be refunded is important to avoid confusion later on. Being informed can help applicants make better decisions regarding their submissions.