Apply for ACLPN certification

ACLPN Eligibility

The following requirements must be met before seeking certification:

  • Currently licensed as a registered LPN or LVN in the United States or an international equivalent (a copy of your license must be submitted with your application)
  • At least two years of experience in clinical practice, education, management or research related to HIV/AIDS
  • Complete and submit an application
  • Pay required fee ($125)

Please complete all of the following required information and make your payment using Paypal. If you would like to pay without using Paypal, please complete the downloadable application. This application can be returned by fax to 330-670-0109, email or mail.

First name *
Middle initial
Last name *
Preferred pronouns *
Mailing address *
City *
State *
Zip code *
Email (If you have already created an account on the National HIV Curriculum, please use the same email address) *
Phone *
Current LPN/LVN License Number *
License state *
License expiration date (mm/dd/yyyy) *

Eligibility and Background Information

Percent of working time currently spent in HIV/AIDS nursing *

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Primary position *

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Area of professional HIV/AIDS emphasis *

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Primary practice setting *

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Experience in HIV/AIDS Nursing *

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Employment status *

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Primary practice location *

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Highest academic level *

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Other certifications held *
How did you hear about the ACLPN program? *
Are you currently a member of ANAC/CANAC? *

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If yes, enter your member ID number
Are you currently or have you been certified in HIV/AIDS nursing? *

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If yes, please supply certification expiration date (MM/DD/YYYY)
Did you take any organized review courses prior to starting the certification process? *

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Date (MM/YYYY)

Optional Information


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Required Documentation

Please attach a copy of your current LPN/LVN license(s) here. If you are unable to upload a copy of your license(s), a copy may be faxed to the national office at 330.670.0109.

File 1

Candidate Agreement

Terms *
I have read and understand the requirements for candidate eligibility. I affirm that all statements given on this application are true and correct to the best of my knowledge and that HANCB is hereby authorized to contact any organization or individual listed hereon to verify my education and licensure history.

Application checklist

Before submitting your application, did you:

  • Complete all required information on the application form
  • Upload a copy of your nursing license
  • Pay the required application fee - Pay through Paypal now

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

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Phone: 800-260-6780 | Fax: 330-670-0109 | Email: