Iowa Board of Nursing
Kathleen R. Weinberg, MSN, RN, Executive Director

INAP Forms

To see an overview of the program click here: INAP Handbook

How nurses can enter the program

Nurses may enter the program by making a self report, the Board may refer them, or another person such as an employer, co-worker or family member may also refer them. Entry into the program is at the discretion of the INAP committee and approval is needed for admission.

At the following link, the form will take you through four documents to complete. The entire series of forms are completed and submitted online. After completion of the document, the system will supply a confirmation document (pdf) of the submission for your records: INAP Nurse Self Report Form. If you complete the online form, you do not need to complete the hard copy forms below. 

Important Forms

To self-report for consideration of admission to the program, please complete and submit the following forms. Click on the blue link to access the pdf version of the  document:
INAP Self Report Form
INAP Release of Information Form
INAP Intake Form
INAP Fact Sheet Confirmation Form

Fax, mail or email the forms to the attention of the INAP Program Coordinator. 

Confidential Fax: 515.725.4017
Mailing address:

400 SW 8th St
Suite B
Des Moines, IA 50309

Participant Forms

Click on the blue link below to access the document:
INAP Quarterly Support Groups Form
INAP Yearly Prescription List
INAP Worksite Monitor Report Form
INAP Worksite Monitor Checklist
INAP Employer/Address Change Form
INAP Treatment Provider Form
INAP Aftercare Form
INAP Travel Request 

Printed from the Iowa Board of Nursing website on October 05, 2022 at 1:07pm.