CES Handbook

A requirement in certain states and territories in the United States for state licensure of registered and practical nurses who were educated outside the United States.

It is also used by U.S. schools and prospective employers

to assess the education of nursing professionals.

The CGFNS Credentials Evaluation Service (CES) is a requirement in certain states and territories in the United States, for state licensure of registered and practical nurses who were educated outside the United States. It is also used by U.S. schools and prospective employers to assess the education of nursing professionals who wish to continue their education or to be employed in the United States.

The Credentials Evaluation Service results in a written report detailing the applicant’s education and professional registration/licensing/certification credentials. Some organizations require the Healthcare Profession & Science report and others require the Full Education Course-by-Course report. Applicants will need to designate the report that is required by the receiving organization.

CGFNS has issued more than 40,000 Credentials Evaluation Service reports to nursing professionals educated outside the United States during the past 17 years.

Credentials Evaluation Service Applicant Handbook

Revised April 2010 Copyright © 2010 CGFNS International. All rights reserved.

CGFNS contact informationCGFNS Customer Service* +1 (215) 349 8767 Appointments* +1 (215) 222 8454Mailing address Suite 400, 3600 Market Street, Philadelphia, PA 19104-2651CGFNS Web site http://www.cgfns.orgCGFNS Connect https://www.cgfns.org/cerpassweb/intro.jsp Apply/Check Status https://www.cgfns.org/cerpassweb/intro.jspEmail https://www.cgfns.org/cerpassweb/processContactUs.do

*check sidebar on https://www.cgfns.org/cerpassweb/processContactUs.do for times

Table of contentsIntroduction to CGFNS Credentials Evaluation Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Choose from two types of reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Document and File Retention Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What this handbook contains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Ways to apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

How to complete the application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Item 1. Credentials Evaluation Service preliminary information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Item 2. Your name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Item 3. Your other names. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Items 4a and b. Your addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 5. Your marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 6. Your birth date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 7. Your gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 8. Your citizenship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 9. Your contact details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 10. Your U.S. Social Security Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 11. Your education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Item 12. Your registration/license/certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Items 13a and 13b. Report recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Item 14. Credentials Evaluation Service application fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Item 15. Other fees and payment information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Item 16. Terms and Conditions of the Credentials Evaluation Service application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Item 17. Attestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Additional CES services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Other CGFNS services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Additional requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

If your application expires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Completing the forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Request for Academic Records/Transcripts form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Request for Validation of Registration/License/Certification form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Authorization to Release Information form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

© 2010 CGFNS International. All rights reserved. The information in this handbook supersedes previously released handbooks and other documents and Web pages.

Before you send your application to CGFNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Checklist to make sure your application is complete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Falsified or altered documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Mailing your application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Guidelines for communicating with CGFNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

CGFNS Connect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Email via Web site. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

On-site appointments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Telephone calls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

In the event of a disaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Credentials Evaluation Service Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Request for Academic Records/Transcripts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Request for Academic Records/Transcripts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Request for Validation of Registration/License/Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Authorization to Release Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Credit Card Payment Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Credentials Evaluation Service Applicant Handbook 1

Revised April 2010

Introduction to CGFNS Credentials Evaluation Service

CGFNS International’s Credentials Evaluation Service (CES) analyzes the credentials of various types of nursing-related professionals educated and registered/licensed/certified outside of the United States who wish to work or study in the United States. The CES report helps qualified nursing professionals meet requirements for licensure or academic admission.

U.S. state boards of nursing and schools require a credentials evaluation to help them appropriately assess educational and professional credentials earned outside of the country. In addition to boards of nursing and schools, employers, as well as recruiters and lawyers working on your behalf may request that you complete the CGFNS Credentials Evaluation Service program and provide them (as a recipient) with one of two reports the service offers. The majority of the U.S. state boards of nursing require CES reports for foreign-educated applicants seeking licensure for either a registered or a practical nurse in their state.

Choose from two types of reportsA Credentials Evaluation Service report analyzes and compares your education and licensure earned outside of the United States to that of U.S. standards. In this objective evaluation, CGFNS carefully assesses the documents received from source agencies. The CES report is advisory in nature and does not make specific placement recommendations. This service does not include an examination. After all required documents, fees and a completed application are received and analyzed, CGFNS prepares a report and sends it to the recipient(s) that you designate. You will also have access to view and print the report in your online applicant account through the CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp.

CGFNS currently offers two types of CES reports. If you are not certain which report you need, please inquire the recipient you designate to receive your CES report. The two reports are described below:

n �Healthcare Profession & Science Report – This report gives general information about the education and professional registration/license/certification that you earned outside the United States. The Healthcare Profession & Science Report describes all foreign education and licensure in terms of similar U.S. professions and indicates the U.S. comparability. When we provide your report to the requested recipient(s), we will attach a copy of your health care academic records/transcripts.

n Full Education Course-by-Course Report – This report contains the same information as the Healthcare Profession & Science Report, but is more detailed and contains an analysis of every course from the educational program.

Both CES reports contain an analysis of secondary and post-secondary (tertiary) education, country-specific background information about schools attended by the applicant, complete dates of attendance, validations of registration/license/certification information received directly from source authorities. All information is explained in terms of U.S. standards. CGFNS may choose to evaluate only the documents that it considers relevant to the CES Review.

Document and File Retention PolicyAll documents and files are retained in accordance with CGFNS’s Document and File Retention Policy.

What this handbook contains

1. Information regarding the Credentials Evaluation Service program and process.2. Instructions for completing

n The Credentials Evaluation Service application (see page 2)n The Request for Academic Records/Transcripts form (see page 6)n The Request for Validation of Registration/License/Certification form (see page 6)n and the Authorization to Release Information form (see page 6)

3. Guidelines for communicating with CGFNS (see page 8)4. The Credentials Evaluation Service application (page 10), a Request for Academic Records/Transcripts (page 16), a Request for

Validation of Registration/License/Certification (page 18), an Authorization to Release Information form (page 19) and a Credit Card Payment Form (page 20)

This handbook describes how to apply for and receive a CES report. There are many steps (see Table 1 on page 2). Please read this entire handbook before completing the application or any of the forms. The detailed description of each step will help you to understand the process.

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CGFNS processes all applications at its headquarters in Philadelphia, Pennsylvania, in the United States. If you have any questions or concerns as you proceed through the CGFNS Credentials Evaluation Service, please contact CGFNS Customer Service by email or by telephone at +1 (215) 349 8767 during the hours listed on our Contact Us page at https://www.cgfns.org/cerpassweb/processContactUs.do. Refer to page 8 for guidelines on communicating with CGFNS. For more information on CGFNS and its services, please visit our Web site at www.cgfns.org.

Table 1: Overview of the steps to receive a CGFNS Credentials Evaluation Service report

ACtIoNS You tAkE ACtIoNS CGFNS tAkES

Identify the report recipient and the type of report required. Complete an online application or download an application and send the original to CGFNS with full payment.

CGFNS sends you a CGFNS ID number.*

Prepare and send the Request for Academic Records/Transcripts form to any nursing or nursing-related post-secondary (tertiary) schools that you attended outside the United States, asking them to send your academic records/transcripts to CGFNS. Send us a photocopy of your secondary school certificate/diploma or results of external exams.

CGFNS reviews all academic records/transcripts that we receive from your schools. Then we compare them to information from our global database to find the specific school and grading system.

Prepare and send the Request for Validation of Registration/License/Certification form to all licensing authorities outside of the United States who have issued you licenses/registrations, asking them to send us the completed form and any attachments.

CGFNS reviews all registrations/licenses and verifies that they come from the issuing source.

Check your status online at www.cgfns.org using your username and password. Respond to any correspondence from CGFNS regarding missing items.

After CGFNS receives and evaluates all the requested documents to satisfy the requirements, we issue a report to the designated recipients. We also provide you access to an applicant copy of the report in your online account.

Please note: All steps must be completed successfully, or application will be deemed incomplete.*Note: If you have ever applied for a CGFNS service in the past, the CGFNS ID number you were issued at that time will remain your permanent CGFNS ID number.

Ways to apply

The most convenient method is to apply online at CGFNS Connect: https://www.cgfns.org/cerpassweb/intro.jsp. Completing the application online will reduce the processing time.

If you apply online, you must still mail certain documents, e.g., copies of secondary school education documents.

The other method is to complete and mail the application on page 10 of this handbook.

How to complete the application

Item 1. Credentials Evaluation Service preliminary informationSee page 10.

a. Please check/tick the box that describes how you learned about CES.b. Please check/tick the box that describes why you selected CGFNS to prepare your evaluation.c. Please print or type the title of your profession.d. Please check/tick yes or no whether you have previously taken and passed the NCLEX-RN® or NCLEX-PN®.e. If you have previously applied to CGFNS for another service, please print or type your CGFNS ID number and your order

number, if known, in the boxes provided. f. Please print or type the name of the country where you worked, your profession and the number of years you worked in

this profession.

Item 2. Your namePlease print or type your name as you would like it to appear on your CES report (see page 10).

If you need to change your name during the application process, CGFNS will only make the change in your file when we receive your signed, written request with legal evidence of name change. Requests to change your mailing address must be in writing or you may make the change online through CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp. In your written request for any of these changes, remember to include your full name, CGFNS ID number and birth date.

Please note: Email requests for name change will not be accepted at any time.

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Item 3. Your other namesPlease print or type all names you have used in the past. This is necessary because CGFNS must be able to recognize all your documents, with any variation or form of your current or previous names. Any name used that is different from your current name should be printed in this space. This would include your birth name as well as different spellings, informal variations, abbreviations and different orders of your name. Include copies of legal documentation or notarized affidavit(s) verifying your name change with your application. For instance, if married, a copy of your marriage certificate or notarized affidavit needs to be attached (see page 10).

Items 4a and b. Your addressesa Please print or type the address where you want to receive mail from CGFNS. If you authorize someone else to receive your

mailings from CGFNS, all correspondence will go to that person’s address.b. Please print or type the address where you reside.

If your address changes at any time during the application process, you must notify CGFNS in writing or make changes to your contact information in CGFNS Connect, the online application system, at https://www.cgfns.org/cerpassweb/intro.jsp. (see pages 10–11).

Item 5. Your marital statusPlease check/tick your marital status (see page 11).

Item 6. Your birth datePlease print or type your birth date, using letters for the month and numbers for the day and year (see page 11).

Item 7. Your genderPlease check/tick the box that indicates whether you are male or female (see page 11).

Item 8. Your citizenshipPlease print or type your birth country, birth state/province, your native language and the country where you hold current citizenship (see page 11).

Item 9. Your contact detailsPlease print or type the contact information where you can be reached. Please answer the questions regarding preferred and optional ways CGFNS may contact you (see page 11).

Item 10. Your u.S. Social Security NumberThe U.S. Social Security Number is an identification number issued by the U.S. Government. If you have one, please print or type it in the spaces provided (see page 11). Otherwise, leave blank.

Item 11. Your educationOn page 11–12, please list all the primary, secondary and post-secondary (tertiary) schools that you attended, and also the countries where the schools were located and your attendance dates. Include all schools, whether or not you completed the program. Include the following information:

n name of the schooln city, state/province, and country where it is locatedn profession title you obtainedn month and year you entered the schooln month and year you completed your coursework or graduated, andn name of diploma or certificate in its original language using English characters

Please check/tick whether or not your education resulted in a degree. Explain any gaps in your educational history on a separate sheet.

Please send a copy of the Request for Academic Records/Transcripts form to each health care school listed, requesting they complete their section and send directly to CGFNS. CGFNS can only accept the academic records/transcripts directly from the school or authorized issuing agency, not from you or a third party.

Note: Please check/tick whether or not any of your health care schools have closed or merged with another school. If yes, please provide the name of school or authority that is in possession of your academic records/transcripts. Please contact the Ministry of Education or appropriate government department and request they send CGFNS a letter advising of that closing.



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Secondary school diploma/certificatePlease submit with your application a legible copy of your secondary school diploma/certificate, results of an secondary school external exam or secondary school equivalent certificate.

n Diploma not in EnglishIf your diploma or certificate is not in English, you must attach a literal English translation, not a summary. The following sentence, referred to as the Certificate of Accuracy, must be typed or written at the end of the translation and must be signed by the translator. It does not need to be notarized. Secondary school certificates or diplomas do not need to be translated by an “official” translator.

Example of Certificate of Accuracythis is to certify that this is a true and correct English translation of the attached photocopy of the original [insert name of document] of [insert applicant name].

n unable to obtain a copy of your diploma or certificateIf you cannot obtain a copy of your diploma, you may request that your secondary school mail a letter directly to CGFNS, confirming your attendance and graduation dates. If you cannot obtain a copy of the certificate that was awarded to you based on the results of an external exam (e.g., GCE, GCSE, Irish Leaving Certificate, WAEC), please ask the examining board to mail a letter directly to CGFNS certifying the grade(s) earned on the examination(s).

Letters submitted by a secondary school/examining board must be written on official stationery, be signed by an appropriate school official or examining board official and be affixed with the school’s/examining board’s stamp or seal.

n Form VIf you were educated in a country where Form V completion is considered finishing secondary school, please submit with your application one of the following documents as verification:– Form V completion statement issued by the appropriate school official or– official secondary school academic records/transcripts showing Form V completion or– external examination results.

Item 12. Your registration/license/certificationSee page 13.

A. Please check/tick the appropriate box that indicates whether or not your diploma gives you the right to practice, because your country does not issue a license. If yes, provide diploma number.

B. Please check/tick the appropriate box which indicates whether or not you are currently registered/licensed/certified, and if you are not, please provide an explanation in the space provided.

C. Please print or type your legal professional title(s), registration number and country(ies) where you are currently registered/licensed.

D. Please print or type the state(s)/province(s)/country(ies) where you have ever held registration/licenses/certification.E. Please check/tick the appropriate box which indicates whether your registration/license/certification has ever been

revoked, suspended or restricted for all registration/licenses/certification that you hold now and/or have held in the past. If yes, please provide an explanation in the space provided.

Items 13a and 13b. Report recipientsList the names and addresses of one or two recipients for your CES report. This could include a state board of nursing, a school or a potential employer. For each recipient, request the report type and purpose. At least one recipient is required to process your application. You are automatically provided with an online applicant copy of the report, it is not necessary to list yourself (see pages 13 and 14).

Please note: The CES report is used by U.S. organizations and schools. If you are indicating an international recipient please provide a written explanation.

Item 14. Credentials Evaluation Service application feesOn page 14, please check/tick only one box of the two types of CES report, either the Healthcare Profession & Science Report or the Full Education Course-by-Course Report. Please check/tick whether you want the CES English language report or any additional service for the Credential Evaluation Service. Add the amounts of the services you checked/ticked to obtain a total of the fees due.

Item 15. other fees and payment informationItem 15 provides information about payment of fees. The fee schedule and policies are found at http://www.cgfns.org/sections/apply/fees.shtml and are subject to change (see page 14).

http://www.cgfns.org/sections/apply/fees.shtml



Revised April 2010

Item 16. terms and Conditions of the Credentials Evaluation Service applicationOn page 15 is a summary of the Terms and Conditions of the Credentials Evaluation Service.

Item 17. AttestationThe attestation on page 15 creates a contract between you (the applicant) and CGFNS. It explains the terms under which CGFNS will process your application. After reading it carefully, sign and date the application. By signing the form, you certify that no portion of the documents submitted to CGFNS on your behalf is falsified, altered or tampered with by any person. CGFNS and others will rely on this application and on the documents and information submitted. If any portion of the application or documents submitted is falsified, altered or tampered with, or if you alter a CES report or misrepresent a copy as an original, CGFNS may take any action against you that it deems appropriate, including barring you from future participation in any CGFNS programs. The consequences could adversely affect your professional license, immigration status, employment and other matters.

SignatureSign the application form with the same name you indicated in Item 2 of this application. You will be required to use the same signature each time you correspond with CGFNS or if CGFNS asks for your signature. The resulting CES report will be issued using the name provided on your application. The application form does not need to be notarized.

Additional CES services

BEFORE REPORT IS ISSUEDn Additional CES report recipients – This is for those who want to send the Credentials Evaluation Service report to more

recipients than the two included in the application (such as other state boards of nursing or schools)n Evaluation of an additional academic credentialn Evaluation of an additional registration/license/certification

AFTER REPORT IS ISSUEDn Duplicate Credentials Evaluation Service report for applicant – This is for applicants who want an unofficial copy of their

report mailed to themn Re-evaluation of a Full Education Course-by-Course Report – After one report has been issued, another Full Education Course-

by-Course Report can be completed and issued to one or two designated recipientsn Re-evaluation of a Healthcare Profession & Science Report – After one report has been issued, another Healthcare Profession

& Science Report can be completed and issued to one or two designated recipientsFees for additional CES services can be found at http://www.cgfns.org/sections/apply/fees.shtml

other CGFNS servicesn Forwarding academic records/transcripts – This is a request for CGFNS to only send copies of your official academic

records/transcripts to a licensing board or educational institutionn Forwarding academic records/transcripts and registration/licenses/certification – This is a request for CGFNS to only send

copies of both your official academic records/transcripts and your official professional registration/license/certification validations to a licensing board or educational institution

n Document translation – This is to request that CGFNS have your required documents translated into EnglishFees for other CGFNS services can be found at http://www.cgfns.org/sections/apply/fees.shtml

Additional requirements

n English language proficiency report – This is for state boards of nursing that require an English proficiency report included with Credentials Evaluation Service report.

n New Jersey, Colorado, Virginia and Wisconsin (practical nurse only) require proof that the applicant has achieved a passing score on the English Proficiency examination required by the Department of Homeland Security for certification of health care workers in Section 343 of the Illegal Immigration Reform Immigrant Responsibility Act of 1996. The Michigan Board of Nursing also requires proof of English language proficiency for applicants who graduated from a nursing school taught in a language other than English. The CGFNS CES report must be accompanied by this English language proficiency report containing the passing scores of the approved English examinations detailed in the CGFNS VisaScreen® handbook.



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If your application expires

If your initial application expires, you may qualify for a reprocess application. You are given 12 months to meet the requirements of the initial application order, after which it expires. If an initial application that has been paid in full expires, you have up to 12 months to apply for a reprocess (another 12 months on that application) and fully pay the reprocess fee listed in the fees table at http://www.cgfns.org/sections/apply/fees.shtml. If you have NOT paid in full, or if fees paid were applied to previous services, and the initial application order expires, you do not qualify for the reprocess, but must submit a new application and pay the full fee to have 12 months to process the application and complete all the requirements. The subsequent 12 months begins when we receive the application. Only one reprocess application is accepted after an initial CES application expires.

Completing the forms

the Request for Academic Records/Transcripts formTo supply CGFNS with the necessary information about your education, you will need to send one copy of the Request for Academic Records/Transcripts form (on page 16) to each health care post-secondary (tertiary) school that you attended outside the United States and request they send us your academic records/transcripts. Complete the requested information in the applicant’s section before sending it to each school that you attended.

Please note: Enclose any payment that your school(s) may require (including translation costs).

IMPoRtANt: We must receive all of your nursing-related academic records/transcripts directly from your school(s). We cannot accept records supplied by you or anyone else other than the school. If CGFNS receive documents that are not in English without an English translation attached, we can have them translated for the fee listed on the fees page at http://www.cgfns.org/sections/apply/fees.shtml, at your request. Further information may be required after your academic record/transcripts are reviewed.

the Request for Validation of Registration/License/Certification formYou must request validations for your current and initial registrations/licenses obtained outside the United States. To do this, use the Request for Validation of Registration/License/Certification included on page 18 in this handbook. Complete the requested information in the applicant’s section at the top of the form before sending it to each licensing authority that issued your registration/license/certification. The section at the bottom titled “FOR LICENSING AUTHORITY TO COMPLETE” is to be completed by them. If you have a diploma that authorized you to practice in your country, send this form to the institution that issued your diploma (for example, your school or the Ministry of Health) and request that an official copy of the diploma in the original language be sent to CGFNS. If CGFNS receive documents that are not in English without an English translation attached, we can have them translated for the fee listed on the fees page at http://www.cgfns.org/sections/apply/fees.shtml, at your request.

Please�note:�If validation of your non-U.S. registration/license/certification was previously mailed to CGFNS for another CGFNS program with an issue date of three or more years ago, it needs to be validated again. Validation of U.S. state licensure is not required for CES reports. Further information may be required after your registration/license/certification forms or diplomas are reviewed.

the Authorization to Release Information formThis form is available on the Web site at http://www.cgfns.org/sections/apply/forms.shtml and page 19 of this handbook.

Because we protect your privacy, your application will only be discussed with you. If you choose to let CGFNS disclose file information or provide file status information to another person, you need to submit an Authorization to Release Information form, to designate an authorized agent. Or, if you choose to have all mail from CGFNS sent to someone else, you can do this by either completing the Authorization to Release Information form or providing the other person’s mailing address on your application form.

The Authorization to Release Information is valid for two years. You can revoke the authorization at any time. We must receive a revocation in writing by postal mail or courier service.

The completed Authorization to Release Information form may be submitted to CGFNS with your application or mailed separately by postal mail or delivered by courier.

Please note: CGFNS only keeps one mailing address per applicant. Therefore, if you choose to have your correspondence from CGFNS sent to an alternative address, all correspondence will be sent to that person. CGFNS cannot be held responsible for any correspondence withheld by a third party you designated as an authorized agent.

Also please note: A letter signed by you authorizing CGFNS to communicate with a relative, recruiter or any other person will not be accepted. Please complete the official Authorization to Release Information form.


http://www.cgfns.org/sections/apply/forms.shtml


Revised April 2010

Before you send your application to CGFNS

Checklist to make sure your application is complete

CHECk EACH ItEM BEloW to ENSuRE tHAt You AVoID CoMMoN APPlICAtIoN ISSuES

Before mailing your application, check to see that you have:

verified that you have completed each item on the application (pages 10–15).

included documentation of your secondary school education or external exam certificate, with literal English translations, including a Certificate of Accuracy (see page 4).

completed the enclosed Request for Academic Records/Transcripts form and sent them to the appropriate schools (see pages 6 and 16).

completed the enclosed Request for Validation of Registration/License/Certification form and sent them to the appropriate licensing authorities (see pages 6 and 18).

checked that every document is either in English or has a literal English translation attached that includes the Certificate of Accuracy, signed by the translator (see page 4).

signed the Authorization to Release Information form, if you would like CGFNS to communicate with someone other than yourself (see pages 6 and 19).

included full payment through a bank check, an international money order (drawn on a United States bank in United States dollars) made payable to CGFNS or credit card payment (Visa, MasterCard or Discover), with the completed Credit Card Payment form. DO NOT SEND CASH (see pages 4 , 14 and 20).

completed and signed this Credentials Evaluation Service application form.

THESE DOCUMENTS HAVE TO BE SUBMITTED DIRECTLY FROM OTHER AUTHORITIES TO CGFNS:

If they are required by your recipient, English language proficiency scores from ETS or IELTS (see page 5).

Completed Request for Registration/License/Certification forms, that you sent to them, and corresponding documents directly sent from all licensing authorities (see pages 6 and 18).

Completed Request for Academic Records/Transcripts forms and corresponding records, that you sent to them, from each post-secondary health care school you attended (see pages 6 and 16).

Certified translation of any documents not in English.

Please note: CGFNS does not return any of the documents that are part of your complete application. Please send only legible photocopies, not originals, of the documents CGFNS requests directly from you. Applications remain open for 12 months.

Falsified or altered documentsIf CGFNS finds that your documents have been altered in any way or that information in your application is falsified, CGFNS will send the CES report to the designated recipients and notify them of the falsification. In addition, your file will be sealed and you will not be eligible in future for other CGFNS services. This includes all documents and application documents submitted by you, or on your behalf by another person. Therefore, before anything is sent to CGFNS, make certain that none of the documents and forms have been falsified or altered in any way.

Mailing your applicationAfter completing your application form, send it to CGFNS International along with a photocopy of your secondary school diploma and all required fees. Send your application documents to the following address:

CGFNS International 3600 Market Street, Suite 400 Philadelphia, PA 19104-2651 USA


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Guidelines for communicating with CGFNS

If you have questions about your application or required documents, we recommend that you first go online to CGFNS Connect Apply/Check Status at https://www.cgfns.org/cerpassweb/intro.jsp on the CGFNS Web site to check the status of your account. You may also contact CGFNS via letter, telephone or through the contact form on our Web site at https://www.cgfns.org/cerpassweb/processContactUs.do. We offer the following guidelines to make this communication easier (see Table 2 on page 9 for additional information).

CGFNS ConnectYou can apply for CGFNS’s services online through CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp. A benefit of CGFNS Connect is that you can access your application status through your browser. By creating an account (through specifying a user name and password) with CGFNS, you can check your application order status, verify receipt of documents and scores, make changes to your contact information, confirm mailing dates and access many other services.

Email via Web siteYou may email CGFNS Customer Service with questions regarding your application through the Contact Us form on our Web site at https://www.cgfns.org/cerpassweb/processContactUs.do.

lettersWhen you mail a letter, it must be written and signed only by you for confidentiality purposes. When you write to us, always include your CGFNS ID number, full name and birth date. CGFNS recommends that you send all correspondence by air mail, and that you consider using express couriers when time is limited.

on-site appointmentsYou or your authorized agent may call +1 (215) 222 8454 to schedule a 30-minute appointment in our CGFNS office in Philadelphia, Pennsylvania, to discuss your file. See the Contact Us form on our Web site at https://www.cgfns.org/cerpassweb/processContactUs.do for appointment days and times.

telephone callsCGFNS Customer Service provides applicant status information by telephone to applicants only. CGFNS will not release information by phone to anyone else unless a completed and signed Authorization to Release Information form has been received from you. If you wish to telephone CGFNS, call CGFNS Customer Service at +1 (215) 349 8767. To save time, have your CGFNS ID number ready. If the Customer Service Representative is unable to adequately verify your identity, information will not be released by telephone.

For the times CGFNS Customer Service is open for telephone calls, go to the Contact Us form at https://www.cgfns.org/cerpassweb/processContactUs. CGFNS Customer Service is not available weekends or U.S. holidays. CGFNS does not accept reverse charge telephone calls.

In the event of a disasterCGFNS makes every effort to ensure that our communication with applicants is straightforward and timely. However, some events are out of our control. Events such as natural disasters, political unrest and postal strikes may occasionally occur. CGFNS cannot be responsible for delays caused by such conditions, but we will make every reasonable effort to notify you when this happens.

Please note: It is your responsibility to notify CGFNS of any change in your contact information, especially in the event of a disaster in your country.


https://www.cgfns.org/cerpassweb/processContactUs.do


Revised April 2010

Table 2: Communication guidelines

REASoN FoR CoMMuNICAtIoN

WHo CAN INItIAtE REquESt?

CoMMuNICAtIoNS CHANNEl You NEED

You want to confirm whether CGFNS received your application documents

Only you or your authorized agent

Email through the Contact Us form on our Web site at https://www.cgfns.org/contact/, write, telephone or visit CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp

Include your full name, CGFNS ID number and birth date

You have a question about a letter that you received from CGFNS


Email through the Contact Us form on our Web site at https://www.cgfns.org/contact/, write or telephone


You need to notify CGFNS of your address change


Email through the Contact Us form on our Web site at https://www.cgfns.org/contact/, write or make changes via the online application system (CGFNS Connect) at https://www.cgfns.org/cerpassweb/intro.jsp


You need to notify CGFNS of a legal name change

Only you Write to CGFNS including legal documentation of name change


©2010 CGFNS. All rights reserved.

https://www.cgfns.org/contact/




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CGFNS International • 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 USA • +1 (215) 222 8454 • www.cgfns.org

Credentials Evaluation Service

Application

Provide all information requested below. Note that inaccuracies will delay the processing of your application. Enter responses legibly. Submit original copy. Retain a copy for your files. See instructions on pages 2 – 5.

Credentials Evaluation Service preliminary informationPlease assist us by answering these questions. Your cooperation will aid us in serving you better in the future.

a. How did you learn about CGFNS’s Credentials Evaluation Service?

nU.S. College/University nState licensure board nRecruiter nU.S. employer nImmigration attorneynCGFNS mailed you information nOther (please explain)

b. Why did you select CGFNS Credentials Evaluation Service over another organization’s service?

nInstructed by your report recipients nYou requested an application nPrice nCGFNS’s reputation nOther (please explain)

c. Title of your profession

d. Have you taken and passed the NCLEX-RN®? nYes nNo Have you taken and passed the NCLEX-PN® ? nYes nNo

e. Your CGFNS ID number, if you have one Order number, if known

f. I worked in as a for years City/Country Profession specialty

1

Your name Print or type your name as you would like it to appear on all correspondence and the report. Please print or type only one letter in each box.

2

First (given) and middle names (leave a space between names)

Last (family / surname) name(s) (leave a space between names)

Your other names (if applicable)

Please print or type all other names appearing in your documents. Include legal documents verifying name change (for example: a marriage certificate).

3

Name before marriage

Other name(s) (leave a space between names)

Your mailing address (Note: You are responsible for notifying CGFNS if your address changes)

Print or type the address where CGFNS will mail all your correspondence.

Street

Street

City

State / Province Post / Zip code

Country

4a

http://www.cgfns.org/


Revised April 2010

Your gendernFemalen Male

7 Your citizenship

Birth country

Birth state/province

Native language

Country where you hold current citizenship

8

Your residential address (Please note: You are responsible for notifying CGFNS if your address changes)

Print or type the address in which you reside.

Street

Street

City


Country

4b

Your marital statusnMarried nDivorcednWidowed nSingle (never married)

5 Your birth date (spell the month, enter numbers for the day and year of your birth)

Month Day Year

6

Your contact details

Telephone (include country code and area code) Mobile phone (include country code and area code) Fax (include country code and area code)

Email (required)

May CGFNS contact you to discuss your transition to practicing in the United States? nYes nNo

May CGFNS send you text messages? nYes nNo

What is your preferred method of communication from CGFNS? nPostal mail nEmail

9

Your u.S. Social Security Number (if you have one)10

11 Your education (Please note: Inaccuracies in this section will result in delay of the processing of your application)

Please list every school in the order you attended them, whether or not you completed each course. Explain any gaps in time in your educational history on a separate sheet. If the school has closed or merged with another school, provide the name and address where your records are located, if known. Also use a separate sheet if you attended more schools than there is room for in each table.

Primary education

Name of primary schools attended Address, city and country

Month/Year

entered

Month/Year

completed

Name of diploma or certificate in its original language

(please use English alphabet)

1/ /

2/ /


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Secondary education (or equivalent)Enclose a photocopy of your diploma, certificate or external exam certificate from your secondary school (or secondary school equivalent), including word-for-word English translations of each of these documents. External exam results and completion date verification must be submitted directly to CGFNS by the examining agency or school.

Name of secondary schools (or equivalent) attended Address, city and country

Month/Year

entered

Month/Year

completed



1/ /

2/ /

Post-secondary (tertiary) non-health care educationComplete all information requested for your non-health care post-secondary (tertiary) schools.

Name of non-health care post-secondary (tertiary) schools

attended Address, city and country

Month/Year

entered

Month/Year completed/graduated



Degree obtained

( )

1/ /

2/ /

3/ /

Post-secondary (tertiary) health care educationComplete all information requested for your health care post-secondary (tertiary) schools. Complete the top section of the Request for Academic Records/Transcripts form and send it to each of your schools to complete. The school is requested to send to CGFNS directly your academic records/transcripts and the completed form.

Name of health care post-secondary (tertiary)

schools attended and contact information

Street, city, state/province, country (will be verified)

Professional title obtained

Month/Year

entered

Month/Year

completed/graduated



Degree obtained

( )

1

/ /CONTACT

2

/ /CONTACT

3

/ /CONTACT

Have any of your health care schools closed or merged with another school? nYes nNo If yes, write the name of school or other authority in your country of education that is in possession of your academic records/transcripts.


Revised April 2010

Your registration/license/certificationPlease provide the following information and forward the Request for Validation of Registration/License/Certification form to all the licensing authorities where you have ever held a registration/license/certification outside of the United States. If your diploma authorizes you to practice in your country, send form to the institution that issued your diploma. Validation of U.S. state licensure is not required for CES reports.

A. If your country does not issue a license, does your diploma give you the right to practice? nYes: number nNo

B. If you are not currently registered/licensed/certified, please indicate nNot currently nNever

and explain:

C. List your legal professional title(s), registration numbers and all countries where you are currently registered/licensed/certified.

D. List any other state(s)/province(s)/country(ies) where you have ever held registration/license/certification.

E. Have any of your registrations/licenses ever been revoked, suspended or restricted for any reason?

nYes nNo If yes, please explain:

12

Report typeRefer to page 1 of this handbook for an explanation of both CES reports.nHealthcare Profession & Science Report nFull Education Course-By-Course Report

Report purposenRN licensure exam nPN licensure exam nRN licensure by endorsement nLPN licensure by endorsement nAcademic admission nEmployment nImmigration nCertification nOther

First of two report recipients At least one report recipient is required to process your application. (Note: You are automatically provided with an online applicant copy of the report, it is not necessary to list yourself as a recipient)

Indicate the name and address of the first recipient of your report.

Organization name

Contact person name and title

Street

Street

City


Country

13a


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other fees and payment informationFees for CGFNS services are located online at http://www.cgfns.org/sections/apply/fees.shtml and fees are subject to change. Full payment for all services must be made before your application and documents can be reviewed. If you use a credit card, you may pay online at https://www.cgfns.org/cerpassweb/intro.jsp or use the Credit Card Payment Form on page 20 in this handbook. We accept Visa, Mastercard and Discover. Alternatively, you may submit an international money order or certified bank check paid in U.S. dollars, drawn on a U.S. bank, and made payable to CGFNS. Personal checks are not accepted. Please do not send cash.

Please note: Any money submitted to CGFNS will first be applied to any unpaid balance on previous orders/services before new orders are processed. The fee covers the expense of processing your application, scanning documents, reviewing your credentials, and preparing and issuing the CES report.

15

Credentials Evaluation Service application feesPlease check/tick only one box of the two types of CES reports. If you are requesting that two different types of reports be issued to your recipients, you should pay for the CES Full Education Course-By-Course Report.

Refer to the fee schedule online at http://www.cgfns.org/sections/apply/fees.shtml.

nCES Healthcare Profession & Science Report $___________

nCES Full Education Course-By-Course Report $___________

nCGFNS English language report $___________

nAdditional CES Services $___________

Total fees due $___________

14

Second of two report recipients (Note: You are automatically provided with a copy of the report, it is not necessary to list yourself as a recipient)

Indicate the name and address of the second recipient of your report. 13b

Organization name

Contact person name and title

Street

Street

City


Country

Report typeRefer to page 1 of this handbook for an explanation of both CES reports.nHealthcare Profession & Science Report nFull Education Course-By-Course Report

Report purposenRN licensure exam nPN licensure exam nRN licensure by endorsement nLPN licensure by endorsement nAcademic admission nEmployment nImmigration nCertification nOther






Revised April 2010

terms and Conditions of the Credentials Evaluation ServiceThe following clarifies the obligations of the Credentials Evaluation Service provider (CGFNS) and applicant (you), as well as the manner in which this service is delivered.

n CGFNS may choose to evaluate only the documents it considers relevant to the CES review.

n All documents submitted, including academic records/transcripts, become the property of CGFNS and will not be returned to you. Do not send original diplomas, degrees, certificates, registrations or licenses.

n If your application includes any falsified, altered or tampered with documents or information, CGFNS will send the report to the designated recipients, and notify them of the falsification.

n No evaluation is conducted until CGFNS receives a complete application and full payment. Please include payment with your application.

n State boards of nursing and applicants have access to CES reports online. All CES reports to recipients other than state boards of nursing (e.g., schools, recruiters, employers and immigration attorneys) are sent via first class mail (within the United States) or air mail (outside of the United States).

n Fees are subject to change and are found at http://www.cgfns.org/sections/apply/fees.shtml

n Any payment sent to CGFNS will be applied first to any unpaid balance from previous orders for products or services before it is applied as payment to this application.

n You are given 12 months to meet the requirements of the initial application order, after which it expires. If an initial application that has been paid in full expires, you have up to 12 months to apply for a reprocess (another 12 months on that application) and fully pay the reprocess fee listed in the fees table at http://www.cgfns.org/sections/apply/fees.shtml. If you have NOT paid in full, or if fees paid were applied to previous services, and the initial application order expires, you do not qualify for the reprocess, but must submit a new application and pay the full fee to have 12 months to process the application and complete all the requirements. The subsequent 12 months begins when we receive the application. Only one reprocess application is accepted after an initial CES application expires.

n No refund is given after an application is submitted.

16

AttestationI agree to the Terms and Conditions of the Credentials Evaluation Service outlined in Item 16.

I certify that all information that CGFNS has received as a part of this application now or in the past from me or from a third party on my behalf, is true and complete. I also certify that all documents which have been submitted to CGFNS for any purpose have not been falsified, altered or tampered with by any person.

I understand that CGFNS and others will rely on this application and on the documents and information submitted, and that if any of the items are falsified, altered or tampered with or if I alter a CGFNS report or misrepresent a copy as an original, CGFNS may take disciplinary action against me as it deems appropriate and the consequences could adversely affect my professional license, immigration status, employment and other matters from which I release CGFNS from all liability.

I authorize CGFNS to disclose the information and documents in this application, the status of any CGFNS certificates, reports or evaluations prepared by CGFNS, any other information obtained by CGFNS, and the results and reasons for any adverse action taken against me by CGFNS to any person or organization I designate in writing or to any other recipient who CGFNS may determine has a legitimate interest in receiving the same, such as government agencies and potential employers.

You must sign and date this application in order for it to be processed.

Your signature Sign entire name

Print your name Date Month / Day / Year

17

©Copyright 2010 CGFNS. All rights reserved.

Mail the completed application and payment to CGFNS International, 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 uSA




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Request for Academic Records/Transcripts

My current name

First (given) name Middle name Last (family / surname) name

Name of school I attended

I attended between the dates of and My birth date Month Year Month Year Month Day Year

My name when I attended this school

First (given) name Middle name Last (family / surname) name

My other names

My CGFNS ID number (if known) My order number (if known)

Applicant signature

My current mailing address

Address

Address City

State / Province Post / Zip code Country

Telephone number (include country code and area code) Fax number (include country code and area code) Email address

FoR SCHool to CoMPlEtE

FoR APPlICANt to CoMPlEtE BEFoRE SENDING to SCHool

SEALOR

STAMP

Dear Registrar:Please complete this section of the form and send it to CGFNS along with the above applicant’s academic record(s)/transcripts listing the courses taken, hours of study and grades earned, accompanied by a certified English translation.

1. Applicant name

2. In what language was the applicant instructed? Applicant’s birth date / / Month Day Year

3. What was the textbook language for the applicant’s program/course of study?

4. Program type (e.g., diploma, baccalaureate) Course of study

5. Attendance dates to Did applicant complete program ? n Yes n No Month Year Month Year

6. School name

7. School address Address City

State / Province Post / Zip code Country

Continued on following page


Revised April 2010

Request for Academic Records/Transcripts

Subject

theoretical instruction

hours*

Clinical practice

hours Subject

theoretical instruction

hours*

Clinical practice

hours

Care of the adult — Medical nursing Humanities

Care of the adult — Surgical nursing Art

Maternal/Infant nursing English

Nursing care of children Foreign language

Psychiatric/Mental health nursing History

Community health/Public nursing Music

Gerontology nursing Philosophy

Gynecology Religion

Neurology Speech

Anatomy

Physiology Social�and�Behavioral�Sciences

Microbiology Anthropology

Pharmacology Archaeology

Nutrition Economics

Mental health concepts Human geography

Political science

Psychology

Sociology

* Includes classroom education, laboratory and planned clinical conferences (ward teaching) hours. CGFNS must have the breakdown of theoretical instruction hours and applicable clinical practice hours for each of the subjects, not combined.

In addition to attaching a copy of the academic record(s)/transcripts(s), please provide specific hours of theoretical instruction and hours of clinical practice for the subject areas listed below. Please Do Not combine subject areas. If they are combined in your curriculum, please estimate the hours of theoretical instruction and hours of clinical practice in each subject area. Both the completed form and educational academic record(s)/transcripts(s) must be sent directly to CGFNS. All documents must be in English.

FoR SCHool to CoMPlEtE, page 2

SEALOR

STAMP

8. School telephone School fax

9. School email address School web address

10. Is this school accredited or government approved? n Yes n No

By whom? Date accredited or approved / / Month Day Year

Is this educational program accredited or government approved? n Yes n No

By whom? Date accredited or approved / / Month Day Year

I hereby attest that the enclosed academic records/transcripts accurately states the courses taken, hours of study and grades received for this applicant.

11. Registrar signature Date / / Do not print, sign entire name. School seal or stamp must cover signature. Month Day Year

Print name Title

CGFNS International3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA

Please send this document and academic record(s)/transcripts(s), in English, in an envelope with your seal or stamp over the flap after sealing. Send via airmail to ➨

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Please send this document and any attachments, in English, in an envelope with your seal or stamp over the flap after sealing. Send via airmail to: CGFNS International, 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA

Request for Validation of Registration/License/Certification

FoR lICENSING AutHoRItY to CoMPlEtE

FoR APPlICANt to CoMPlEtE BEFoRE SENDING to lICENSING AutHoRItY

SEALOR

STAMP

My current name

First (given) name Middle name Last (family/surname) name

My birth date My CGFNS ID number My order number Month Day Year (if known) (if known)

Registration/License/Certification number Professional title

The registration/license/certification was issued under the name

First (given) name Middle name Last (family/surname) name

Applicant signature

My current address

Address

Address City

State/Province Post/Zip code Country

Dear Licensing Authority:Please promptly complete this section of the form and attach a copy of the above applicant’s professional registration/license/certification documents issued in its original language, accompanied by a certified English translation.

1. This is to certify that was first issued registration / license / diploma Applicant name

number to practice as a on / / Specify legal title Month Day Year

The expiration date of this registration / license is / / Applicant birth date / / Month Day Year Month Day Year

2. Ability to practice granted by: n National / Provincial / State examination n LIcensure exam date / / Month Day Year n Registration n Diploma (NOTE: Please attach a copy of the original language diploma/certificate with literal English translation)

n Review of another license (endorsement) n Other

3. Status: n Active / Current n Expired n Inactive n Restricted**Please attach an explanation if the applicant’s registration / license / diploma has ever been revoked, suspended, limited or placed on probation.

4. Name and address of professional school

5. Graduation date / / Month Day Year

6. Is this school accredited or government approved? n Yes n No

By whom? Approval date /

Is this educational program accredited or government approved? n Yes n No By whom?

7. Program type: n Diploma n Baccalaureate degree n Associate degree n Other (specify)

8. Licensing or school authority signature Date / / Do not print, sign entire name. Licensing or school authority seal or stamp must cover signature. Month Day Year

Print name

Licensing or school authority title

State / Province and country

Telephone number (include country code and area code) Fax number (include country code and area code)

Email address Web address

( also validation of diploma if it authorizes you to practice in your country)

Revised April 2010


Authorization to Release Information

NotICE: By signing below you (1) allow CGFNS to disclose confidential, personal, private information about you and your file at CGFNS to the person designated below; (2) give up the right to receive information from CGFNS directly; and (3) release and indemnify CGFNS, its members, trustees, officers and employees from any liability for losses, damages or claims of any type arising out of actions taken by CGFNS in reliance upon this Authorization to Release Information, hereafter known as “Authorization”.

This Authorization will remain valid for two years from the date supplied by you on the “Date” line below (or if no date is supplied, from the date this Authorization is received by CGFNS).

REVoCAtIoN: This Authorization can be revoked by submitting a new authorization dated and signed after the initial authorization. In addition, you may revoke this Authorization in writing at any time, which will be effective on or after the 30th day after CGFNS receives it, by regular mail or courier, at its headquarters office in Philadelphia, Pennsylvania, USA.

AutHoRIZAtIoN: I authorize CGFNS to release to the authorized agent indicated by me below, any and all information about me and my application/order for services from CGFNS, including, and without limitation, the status of my application/order, the results of any credentials review, examination or test and any other information in or relating to my file at CGFNS. I understand that all mail (including certificates, exam scores and reports) will be sent to the authorized agent.

This authorization revokes all previous authorizations submitted by the applicant.

Your CGFNS ID number (if known) Your birth date (spell the month and enter numbers for the day and year)

Month Day Year12

Your signature (the applicant)

Your signature Date / / Do not print Month Day Year

Print your name

3

Your authorized agent (please print)

Your contact’s name

The organization your contact is representing

Your contact’s address

Day telephone Fax

Evening telephone Email

4

3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA • +1 (215) 222 8454 • www.cgfns.org


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Cardholder informationCardholder name (as it appears on card)

Applicant birth date (spell the month and enter numbers for the day and year)

Month Day Year

3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA • +1 (215) 222 8454 • www.cgfns.org

INTERNATIONAL COMMISSION onHEALTHCARE PROFESSIONSA division of CGFNS International

COMMISSION on GRADUATES ofFOREIGN NURSING SCHOOLSA division of CGFNS International

Please type or print legibly. To pay by credit card, please fill in below your name as it appears in your application/order and your CGFNS ID number (if known). Complete the cardholder information as requested.

Applicant name1

First (given) and middle names (leave a space between names)

Last (family/surname) name(s) (leave a space between names)

CGFNS Applicant ID number (if known)2 3

4

First name, middle initial and last name (Leave a space between names)

Credit card number CVV2 number* (see below for explanation)

Expiration date Month Year Total charges US $ (see fees page online at http://www.cgfns.org/sections/apply/fees.shtml)

*Explanation of credit card CVV2 number

Visa and MasterCard: This number is printed in the signature area on the back of the card (they are the last 3 digits after the credit card number).

Credit card type (check one) nVisa nMastercard nDiscover

Cardholder address (for processing credit card payments only)

Street

Street

City State/Province

Post/Zip code Country

Cardholder signature (authorization for payment)

I hereby authorize a charge to my credit card for the total of all services ordered in this application including any fee adjustments in effect as of the date the order is received.

Signature of authorized cardholder

5

Credit Card Payment Form

http://www.cgfns.org


3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 USA

Phone: +1 (215) 222 8454 • Web: www.cgfns.org

Revised April 2010 ©2010 CGFNS. All rights reserved.

CGFNS MissionTo serve the global community through programs and services that verify and promote

the knowledge-based practice competency of health care professionals.

Documents

CES Handbook