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It also requests background data supporting HIV/AIDS nursing certification reporting, including practice time, position, emphasis area, practice setting, experience, employment status, location, education level, other certifications, and ANAC membership. The form includes payment instructions, credit card fields, late fee rules, and Category I continuing education requirements for HIV/AIDS nursing, specifying minimum hours, course approval sources, CEP definitions, audit documentation, and a course table.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/aclpn-recertification-application-form/327241/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/aclpn-recertification-application-form/327241.png","ImageObject",300,407,{"name":92,"@type":93},"Elsa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What disclosures are required regarding licensure status and actions against the LPN license?","Question",{"text":112,"@type":113},"Applicants must indicate whether the LPN license is in good standing in all jurisdictions where the person is licensed as an RN, with explanation if not. They must also state whether any action was taken against the LPN license in the past four years, with explanation if yes.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How is Category I continuing education for HIV/AIDS nursing defined and calculated?",{"text":117,"@type":113},"Category I requires 30 hours minimum, with courses taken during the current certification period. One educational contact hour (50 minutes of actual classroom time) equals one CEP, and audited applicants must provide a photocopy of the continuing education certificate with required details.",{"name":119,"@type":110,"acceptedAnswer":120},"What are the course approval and accrediting requirements for HIV/AIDS nursing continuing education?",{"text":121,"@type":113},"All CEPs must be approved by specified credentialing bodies such as a state board of nursing, ANCC, ANAC, AANP, or an international equivalent. Accrediting agency names for each course must be listed on the application form.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},327241,1790071818,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":36},137455077381,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","ACLPN RECERTIFICATION APPLICATION FORM  \n\n| Last Name |  |  |  | First name |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Address |  |  |  | City, State, Zip Code |  |  |  |\n| Home Phone |  |  |  | Work Phone |  |  |  |\n| Fax |  |  |  | Email |  |  |  |\n| ACLPN Information |  |  | Registered Nurse Information |  |  |  |  |\n| Year of Initial\u003Cbr>Certification |  |  | State of Licensure |  |  |  |  |\n| Year of Last Recertification |  |  | LPN License Number |  |  |  |  |\n| ACLPN Certificate Number |  |  | LPN License Expiration Date |  |  |  |  |\n|  |  |  | Is your LPN license in good standing in all jurisdictions in which you are currently licensed as a RN? |  | 􀂉 Yes |  | 􀂉 No\u003Cbr>Please explain on separate sheet of paper |\n|  |  |  | During the past four years, has any action been taken against your LPN license? |  | 􀂉 Yes\u003Cbr>Please explain on a separate sheet of paper |  | 􀂉 No |\n\nMail completed application form with appropriate fee to:  \nHANCB Recertification  \n11230 Cleveland Ave NW \\#986 Uniontown, OH 44685  \nRecertification Fee, ANAC Member: $  \nRecertification Fee, Non-ANAC Member: $  \nLate Fee: $50 (all applications postmarked after certificate expiration date; if more than 30 days after expiration date, application will not be accepted)  \nBackground Information:  \nDirections: Please complete the following information to allow us to describe the group of nurses who are certified in HIV/AIDS nursing. Please mark directly on this application.  \nA. Percent of Time Currently Working in HIV/AIDS Nursing  \n􀂁 Less than 25%  \n􀂁 25-50%  \n􀂁 51-75%  \n􀂁 more than 75%  \nB. Primary Position (Select only one response)  \n􀂁 Staff nurse/clinician  \n􀂁 LPN/LVN  \n􀂁 Head Nurse/Nurse Manager  \n􀂁 Nurse Case Manager/Coordinator  \n􀂁 Nurse Practitioner  \n􀂁 Clinical Nurse Specialist  \n􀂁 Patient Educator  \n􀂁 Nurse Educator/Faculty Member  \n􀂁 Director/Assistant Director  \n􀂁 Nurse Researcher  \n􀂁 Infection Control Practitioner  \n􀂁 Consultant  \n􀂁 Sales/Marketing/Industry: Nursing Rep  \n􀂁 Counselor  \n􀂁 Other  \nC. Area of Professional HIV/AIDS Emphasis  \n􀂁 Adult  \n􀂁 Pediatrics  \n􀂁 Both adult and pediatrics  \nD. Primary Practice Setting (Select only one response)  \n􀂁 Inpatient: community hospital  \n􀂁 Inpatient: university affiliated hospital  \n􀂁 Outpatient/ambulatory care  \n􀂁 Public/community health  \n􀂁 Hospice  \n􀂁 Home Care  \n􀂁 School of Nursing  \n􀂁 Private/Group Practice  \n􀂁 Physician’s office  \n􀂁 Substance Abuse Treatment Center  \n􀂁 Long-term Care Facility  \n􀂁 Forensic Setting (jail, prison)  \n􀂁 Community-Based Organization  \n􀂁 HIV Testing Center  \n􀂁 Primary Prevention Program  \n􀂁 Clinical Trial Group  \n􀂁 Family Planning/STD  \n􀂁 Other  \nE. Experience in HIV/AIDS Nursing  \n􀂁 Less than 2 years  \n􀂁 2 years  \n􀂁 3-6 years  \n􀂁 7-10 years  \n􀂁 more than 10 years  \nF. Employment Status  \n􀂁 Full-time  \n􀂁 Part-time  \n􀂁 Unemployed  \n􀂁 Retired  \nG. Primary Practice Location  \n􀂁 Rural  \n􀂁 Suburban  \n􀂁 Urban (less than 1 million population)  \n􀂁 Urban (more than 1 million population)  \n􀂁 Mixed  \n􀂁 Not applicable  \nH. Highest Academic Level Earned  \n􀂁 LPN/LVN Certificate  \n􀂁 Diploma in Nursing  \n􀂁 Associate Degree, Nursing  \n􀂁 Baccalaureate, Nursing  \n􀂁 Baccalaureate, Other  \n􀂁 Master’s in Nursing  \n􀂁 Master’s, Other  \n􀂁 Doctorate in Nursing  \n􀂁 Doctorate, Other  \n􀂁 Other  \nI. Other Certifications Held (Darken ALL that apply)  \n􀂁 None  \n􀂁 RN, C  \n􀂁 OCN  \n􀂁 CIC  \n􀂁 CCRN  \n􀂁 CEN  \n􀂁 CRNH  \n􀂁 RN, CS  \n􀂁 Other  \nJ. Are you currently a member of ANAC?  \n􀂁 No  \n􀂁 Yes  \nIf yes, please provide current membership number  \nOPTIONAL INFORMATION:  \nRace/Ethnicity  \n􀂁 African American  \n􀂁 Asian/Pacific Islander  \n􀂁 Hispanic/Latino/Latina  \n􀂁 Native American  \n􀂁 White  \n􀂁 Other  \nAge Range:  \n􀂁 Under 25  \n􀂁 25-29  \n􀂁 30-39  \n􀂁 40-49  \n􀂁 50-59  \n􀂁 60 or older  \nGender:  \n􀂁 Female  \n􀂁 Male  \n􀂁 Transgender  \n􀂁 Non-binary  \n􀂁 Prefer not to answer  \nI affirm that all statements given on this application are true and correct to the best of my knowledge and that the HANCB  ","cbCaiaiesEp1N5gQ","https://ap.wps.com/l/cbCaiaiesEp1N5gQ","pdf",294651,16,"English","# ACLPN Information\n## Registered Nurse Information\n## Licensure Disclosures\n# Background Information (HIV/AIDS Nursing)\n## Practice Time and Primary Position\n## Professional Emphasis and Practice Setting\n## Experience, Employment, Location, Education\n## Other Certifications and ANAC Membership\n# Affirmation and Signature\n# Credit Card Payment Section\n# Category I - HIV/AIDS Nursing Continuing Education\n## Minimum hours and eligibility period\n## Approved accrediting sources\n## CEP definition and audit requirements\n## Course tracking table","[{\"question\":\"What disclosures are required regarding licensure status and actions against the LPN license?\",\"answer\":\"Applicants must indicate whether the LPN license is in good standing in all jurisdictions where the person is licensed as an RN, with explanation if not. They must also state whether any action was taken against the LPN license in the past four years, with explanation if yes.\"},{\"question\":\"How is Category I continuing education for HIV/AIDS nursing defined and calculated?\",\"answer\":\"Category I requires 30 hours minimum, with courses taken during the current certification period. One educational contact hour (50 minutes of actual classroom time) equals one CEP, and audited applicants must provide a photocopy of the continuing education certificate with required details.\"},{\"question\":\"What are the course approval and accrediting requirements for HIV/AIDS nursing continuing education?\",\"answer\":\"All CEPs must be approved by specified credentialing bodies such as a state board of nursing, ANCC, ANAC, AANP, or an international equivalent. Accrediting agency names for each course must be listed on the application form.\"}]","ACLPN Recertification Application Form | PDF",1789976785]