Kentucky
Sign In
Home
Apply
Method Of Instruction Course Do N...
Submit New Application
Method of Instruction Course - Do not use until your MOI application is submitted and approved Application
Legal First Name
Middle
Legal Last Name
Birthdate
Email
Phone
SSN
Gender
Male
Female
Other
Address
Address
City
State
Select State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WV
WI
WY
Zipcode
RN License Information
License Number
Expires
Affidavit
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
Application Fee $250.00
Non-Refundable.
All fees are non-refundable.
Cardholder Name
Card Number
Exp Month
Select Month
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
Exp Year
Select Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Security Code
Cardholder Address
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WV
WI
WY
Zip Code
Send Application