W. Va. Code R. § 19-15-4 - Required Documentation for Waiver of Initial Licensure Fees
4.1. Individuals
requesting a waiver of initial licensure fees for low income or military
service personnel and their spouses, shall submit with the application for
licensure the initial licensure waiver RN-LIW or RN-MFW form and the
appropriate documentation as specified in this section.
4.2. To establish low income eligibility for
the initial licensing fee waiver, an applicant shall submit to the Board
evidence that the adjusted gross income of the household of the applicant is
below 130% of the federal poverty level by submitting a Federal Tax Return or
documentation of eligibility for:
4.2.1.
Temporary Assistance for Needy Families Program;
4.2.2. Medicaid; or
4.2.3. Supplemental Nutrition Assistance
Program;
4.3. To
establish military family eligibility for the initial licensing fee waiver, an
applicant shall submit to the Board proof of qualifying military service and
proof of eligibility as a qualifying spouse or surviving spouse, as follows:
4.3.1. A service members DD-214
form;
4.3.2. A service members
NGB-22 form;
4.3.3. A service
members DD-1300 form; or
4.3.4. A
copy of their current military orders; and
4.3.5. A copy of the marriage certificate
with the qualifying service member and, where applicable, the death certificate
of the service member if the surviving spouse is requesting the military family
waiver.
4.4. Honorably
discharged applicants shall submit a completed application, and a DD-214 form
or an NGB-22 form showing the applicant has been an honorably discharged from
military service.
Notes
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