Apply for ACLPN recertification

1. Download and complete the Continuing Education Credits Form. For a complete list of approved continuing education activities, please click here. Your application is considered incomplete and will not be processed without this documentation.

2. Complete the application details below and attach your Continuing Education Credits form in the Required Documentation section.

3. Make your payment online 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 *
Suffix
Mailing address *
Apt/Suite
City *
State *
Zip code *
Email *
Phone *
Year of initial certification *
Year of last recertification *
ACLPN Certificate Number *
Current LPN License Number *
License state *
LPN License expiration date (mm/dd/yyyy) *
Is your LPN license in good standing in all jurisdictions in which you are currently licensed as a RN? *

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During the past four years, has any action been taken against your LPN license? *

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Background Information

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

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Primary position *

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Primary practice setting *

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Area of professional HIV/AIDS emphasis *

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Experience in HIV/AIDS nursing *

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Primary practice location *

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Highest academic level *

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Other certifications held *
Employment status *

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Are you currently a member of ANAC? *

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If yes, enter your member ID number

Optional Information

Race

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Age

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Gender

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Required Documentation

Please attach the completed Continuing Education documentation form and any necessary licensure explanations below. A minimum of 60 CEPs are needed for recertification. Find the full ACLPN recertification policies and procedures 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
File 2
File 3

Candidate Agreement

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

Applications are not considered complete until payment is received by HANCB. Pay through Paypal now.




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© 2021 HIV/AIDS Nursing Certification Board | 11230 Cleveland Ave NW #986, Uniontown, OH 44685
Phone: 800-260-6780 | Fax: 330-670-0109 | Email: hancb@anacnet.org