Cgfns Form
Cgfns Form
Applicant Handbook
The CGFNS Certification Program consists of a Qualifying CGFNS Certification Program Certificate
Examination, a Credentials Evaluation, and demonstration of
English language proficiency. The CGFNS Certification holders consistently have a higher rate
Program (CP) is designed only for first-level, general nurses
(registered nurses-RNs) educated and licensed outside of the of success on the NCLEX-RN® examination
United States. than internationally-educated nurses
The Certification Program is valuable to internationally
educated registered nurses for the following reasons:
who do not hold the Certificate.
• The CGFNS Certification Program Certificate is required of
internationally-educated registered nurses by a majority of
U.S. states in order to take the NCLEX-RN® licensure examination.
• CGFNS Certification Program Certificate holders consistently
have a higher rate of success on the NCLEX-RN® examination
than internationally-educated nurses who do not hold the Certificate.
• The CGFNS Certification Program Certificate helps internationally-
educated registered nurses in their quest for an occupational
visa to work in the U.S. CGFNS was named in section 343
of the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996 as an organization qualified to
administer a screening program for healthcare professionals
seeking an occupational visa. For internationally-
educated nurses who have not taken the NCLEX-RN® examination,
passing the CGFNS Qualifying Examination fulfills one of the
requirements of section 343.
CGFNS has rostered and tested over 325,000 Certification
Program applicants since 1977. Over 125,000 of those applicants
have met all stated requirements at the time of their application
and have received their Certification Program Certificate.
Table of Contents
Introduction to CGFNS Certification Program...................................................................................................................................................................... 2
What This Handbook Contains ............................................................................................................................................................................................ 2
The Three-Part CGFNS Certification Program................................................................................................................................................................ 2
Chart 1: Overview of the Process for CGFNS Certification Program ...................................................................................................................... 3
How to Apply ...................................................................................................................................................................................................................................... 3
Chart 2: Checklist To Prevent Common Application Problems.................................................................................................................................. 7
Request for Academic Records Form and Full Academic Transcript .......................................................................................................................... 7
Validation of Registration/License Form ................................................................................................................................................................................ 8
CGFNS Reviews Credentials to Determine Eligibility ........................................................................................................................................................ 8
Are You a First-Level, General Nurse? .............................................................................................................................................................................. 8
Do You Meet the Educational Requirements? ................................................................................................................................................................ 9
Do You Have Appropriate Registration Documents? .................................................................................................................................................... 9
Are Documents Authentic? .................................................................................................................................................................................................... 9
CGFNS Notifies Eligible and Ineligible Applicants.............................................................................................................................................................. 9
Eligible Applicants .................................................................................................................................................................................................................... 9
Ineligible Applicants .................................................................................................................................................................................................................. 9
Exam Rostering for Eligible Applicants .................................................................................................................................................................................. 10
Your Exam Date and Location .............................................................................................................................................................................................. 10
Changing Exam Date or Location, Your Name or Address .......................................................................................................................................... 10
Registering for an English Proficiency Examination.......................................................................................................................................................... 11
Preparing for the CGFNS Qualifying Exam and English Proficiency Exams .......................................................................................................... 12
Nursing Review .......................................................................................................................................................................................................................... 12
The Official Study Guide for the CGFNS Qualifying Exam .......................................................................................................................................... 12
Supplements to the Official Study Guide for the CGFNS Qualifying Exam.............................................................................................................. 12
Understanding Multiple-Choice Testing ............................................................................................................................................................................ 12
English Review ............................................................................................................................................................................................................................ 13
Taking the CGFNS Qualifying Exam .......................................................................................................................................................................................... 13
Preparing for the CGFNS Qualifying Exam ...................................................................................................................................................................... 13
At the Exam Center .................................................................................................................................................................................................................. 13
The Exam Schedule .................................................................................................................................................................................................................. 14
Inappropriate Activities ............................................................................................................................................................................................................ 14
Exam Results and Diagnostic Profile ...................................................................................................................................................................................... 14
Earning the CGFNS Certificate ............................................................................................................................................................................................ 15
Unsuccessful Completion of the Certification Program................................................................................................................................................ 15
Re-Scoring of Exams ................................................................................................................................................................................................................ 15
Guidelines for Communicating with CGFNS.......................................................................................................................................................................... 15
Non-applicant Inquiries .......................................................................................................................................................................................................... 15
World Wide Web ........................................................................................................................................................................................................................ 16
E-mail ............................................................................................................................................................................................................................................ 16
Letters ............................................................................................................................................................................................................................................ 16
On-site Appointments .............................................................................................................................................................................................................. 16
Telephone Calls .......................................................................................................................................................................................................................... 16
In the Event of a Disaster ........................................................................................................................................................................................................ 16
Chart 3: Communication Guidelines .................................................................................................................................................................................. 17
Authorization to Release Information Form.......................................................................................................................................................................... 19
Credit Card Payment Form............................................................................................................................................................................................................ 19
Request for Validation of Registration/License For Certification Program.............................................................................................................. 21
Request for Academic Records Form........................................................................................................................................................................................ 23
CGFNS Certification Program Application Form.................................................................................................................................................................. 25
Introduction to CGFNS Certification Program
Every year, thousands of nurses from around the world decide that they would like to practice as registered nurses in the United
States (U.S.). The Commission on Graduates of Foreign Nursing Schools (CGFNS), and the CGFNS Certification Program (CP),
can help you work toward your goal. The Certification Program is a three-part program designed specifically for first-level, general
(Registered) nurses educated and licensed outside the United States who are eligible to practice as registered nurses in the United
States. It includes:
• Verification and Evaluation of education and licensure
• Qualifying Exam of nursing knowledge
• English language proficiency examination
To be eligible for a CGFNS CP Certificate, you must meet the educational and licensure credentials criteria and pass the two exams
mentioned above.
Part Three - An English Language Proficiency Examination: TOEFL, TOEFL iBT, TOEIC, or the Academic Module of IELTS
An English language proficiency examination is taken to determine your proficiency in the English language. The following
examinations have been approved to meet the English language proficiency requirement:
• Test of English as a Foreign Language (TOEFL)
• Test of English as a Foreign Language – Internet-based (TOEFL iBT)
• Test of English for International Communicators (TOEIC)
• International English Language Testing System (IELTS) (Academic Module)
See page 11 for contact information.
Prepare and send Request for Validation of Registration/License Forms to the licensing
authority in your country of nursing education, and the licensing authority(ies) where
you are currently registered/licensed. Prepare and send a Request for Academic
Records Form to your School.
Prepare for the CGFNS Qualifying Exam and English proficiency exam. CGFNS notifies eligible applicants of date and location of CGFNS Qualifying Exam.
Take the CGFNS Qualifying Exam and English proficiency exam. CGFNS notifies you of Qualifying Exam results.
How to Apply
The most convenient way for you to apply is online at www.cgfns.org. Completing the application online will give you the advantage
of speeding up the process. You can download a printable version of the application for the CGFNS Certification Program at
www.cgfns.org . You can also find an application form in the back of this handbook. Please follow the application instructions exactly
as indicated below.
Item 5: Gender
Enter whether you are male or female.
Item 9: Your Telephone Number, Mobile (cell phone) Number, Fax Number and E-mail Address
Please enter contact information where you can be reached. Please answer the questions regarding cell phone and text messaging
contact by CGFNS.
Certificate Of Accuracy
“This is to certify that this is a true and correct English translation of the attached photocopy of the original
[name of document] of [applicant’s name].”
Signature
Sign the Application Form with the same name as you indicated in Item 2 of the application. You will be required to use the same
signature each time you correspond with CGFNS or when CGFNS asks for your signature. If you earn a CGFNS CP Certificate, it
will be issued using the name provided on your application. The Application Form does not need to be notarized.
CGFNS will not return any of the documents that are part of your complete application.
Remember to send only legible photocopies, not originals, of the documents CGFNS requests directly from you. Applications
remain open for one year (12 months).
Section I
Complete items 1-9. Make sure this information is consistent with your application.
Section II
The nursing school must enter the number of hours of theoretical instruction and number of hours of clinical practice you received
in each of the areas of nursing listed on the form. An incomplete Request for Academic Records Form will result in delays in
processing your application.
• Only Request for Academic Records Forms and academic records/transcripts submitted to CGFNS directly by your school will
be processed. Forms and transcripts submitted by you, even if in a sealed envelope from the school, cannot be accepted,
and you will be asked to send a new form to your school who will then complete their portion of the form and include the
transcripts and send directly to CGFNS.
• If you attended more than one nursing school, including a school of midwifery, photocopy both sections of the Request for
Academic Records Form after you have filled out Section I. Send the copies to each school you attended, asking that Section II
be completed.
Ineligible Applicants
If, after review of your credentials, CGFNS finds that you are not eligible either for the CGFNS CP Qualifying Exam or to receive
the CP Certificate, you will receive a letter explaining the reasons. It is not unusual for applicants to be declared ineligible for the
exam. In many cases, applicants may become eligible for the exam with further education.
Contact Information
You must apply directly with one of the above companies to take any of the above-mentioned English exams. For TOEFL or TOEFL
iBT, please reference code number 9988 on your application form to ensure that your TOEFL results will be sent electronically to
CGFNS. For IELTS, please be sure to request that your test scores are made electronically available to CGFNS. For TOEIC, please be
sure to request that your scores be mailed to CGFNS.
Supplements to the Official Study Guide for the CGFNS Qualifying Exam
CGFNS has developed additional study materials for sale on each of the four major areas of nursing in the United States. Each of
these publications comes complete with a practice examination of 125 questions related to the publications subject, and explanations
of why the correct answer is correct and why the other answer choices are incorrect. These supplemental study guides may be
ordered from the CGFNS Storefront, www.cgfns.org.
• The Adult Health Nursing Study Guide Supplement focuses on nursing knowledge exam questions associated with the adult
patient with acute or chronic illness in any healthcare setting.
• The Nursing of Children Study Guide Supplement focuses on nursing knowledge exam questions associated with preventing
illness and injury in children.
• The Maternal/Infant Nursing Study Guide Supplement focuses on nursing knowledge exam questions associated with the care
of childbearing women and their families through all stages of pregnancy and childbirth, as well as the first four weeks
following birth.
• The Psychiatric/Mental Health Nursing Study Guide Supplement focuses on nursing knowledge exam questions associated with
the interpersonal process that promotes and maintains patient behavior (mental health).
English Review
To help you become familiar with the types of questions on the English proficiency exam, CGFNS has included English language
practice questions in its Official Study Guide (see page 12). English study materials also may be obtained directly from the
examining body (see page 11). You may also purchase English language practice audio tapes from CGFNS. Arrangements to take
the English proficiency exam must be made directly with the appropriate examining body (see page 11).
Inappropriate Activities
Because the CGFNS Qualifying Exam is designed to measure your nursing knowledge, no one may give or receive help during the
exam. Inappropriate help includes getting assistance from anyone other than a CGFNS staff person, helping another test taker,
referring to other printed material or working on an inappropriate section of the exam. Anyone who gives or receives such help will
be asked to leave the room. That person’s answer sheets will not be scored. The event will be recorded and reported to CGFNS, and
the person may be barred from taking any future CGFNS Qualifying Exams.
The attestation section of the CGFNS Certification Program application form indicates that applicants should not engage in any
activity which could be interpreted as restructuring of questions that are on the exam. Applicants should refuse any requests by
third parties, i.e. friends, recruiters or employers to memorize questions or give them details regarding the content of the tests.
Such activities will result in the applicant’s test being voided and may prevent them from being eligible for all future exams.
If you see anyone not following the rules and instructions, or if you observe a disturbance of any kind during the exam, please
report this to the CGFNS exam supervisor at the time it occurs or before you leave the Exam Center. You may also communicate
your experience in writing to the following address:
CGFNS
ATTN: Test Administration Department
3600 Market Street, Suite 400
Philadelphia, PA 19104-2651
USA
All allegations related to inappropriate activities are taken seriously by CGFNS and will be investigated to ensure the integrity and
validity of the exam.
Re-Scoring of Exams
The CGFNS Qualifying Exam is scored by computer because this is the most reliable way to score multiple-choice tests. Afterward,
any exam answer sheets with unusual results are hand-scored to further ensure reliability. However, if you have failed the exam and
feel that another hand-scoring of your answer sheet would be useful, you may request it. CGFNS will re-score an exam for a fee, as
long as the exam is no more than two years old.
To request this service, write to CGFNS, indicating the date of the exam you wish to have re-scored. Also include your CGFNS ID
Number, your birth date and documentation of any name change since you took the exam to be re-scored. Sign the letter, enclose
the proper fee, address the envelope to CGFNS, and mark it “ATTN: Re-Scoring.”
E-mail
Applicants may contact the CGFNS Customer Service Department with questions regarding their application by e-mail at
www.cgfns.org “Contact us” link.
Letters
CGFNS treats your application as confidential, to be discussed only with you. When you send a letter, it must be written and signed
only by you. When you write to us, always include your CGFNS ID Number, full name, and date of birth. CGFNS recommends
that you send all correspondence by first-class mail, and that you consider other faster mailing options when time is limited.
On-site Appointments
An applicant or authorized agent may make an appointment to discuss the applicant’s file by scheduling a 30-minute appointment
in our CGFNS office in Philadelphia, PA. Appointments are available Monday through Friday and may be made by calling the office
at 215-222-8454
Telephone Calls
The CGFNS Customer Service Department 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 the applicant. If you wish to telephone CGFNS, call our Customer Service Department at (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.
Phone lines are generally open Monday through Thursday between 9:00 a.m. and 5:00 p.m. (Eastern Time in the United States), and
9:00 a.m. and 4:30 p.m. on Friday. The phone lines are not open evenings, weekends or on U.S. holidays. In an effort to keep our
costs to you at a minimum, CGFNS will not accept collect telephone calls.
CGFNS also has an Automated Voice Response telephone system that is available 24 hours a day, 7 days a week. By inputting their
identification number and date of birth, applicants can verify receipt of documentation and examination scores, confirm file status,
and access other information. Applicants can reach this system at (215) 599-6200.
You want to confirm that your application Only you or your authorized agent E-mail through our website www.cgfns.org Include your Full Name, CGFNS ID number
documents have been received by CGFNS, or “Contact Us”, write, telephone, or visit the On- and date of birth.
that you have been scheduled for an exam. line Application System at www.cgfns.org.
You have a question about a letter that you Only you or your authorized agent E-mail through our website www.cgfns.org CGFNS advises you to write for this kind of
received from CGFNS. “Contact Us” , write, telephone or make an information. If you must phone, have your
appointment to visit on-site. CGFNS ID number available and date of birth.
You need to notify CGFNS to change your Only you or your authorized agent E-mail through our website www.cgfns.org Include your Full Name, CGFNS ID number and
address. “Contact Us”, write or make changes online at date of birth.
www.cgfns.org via the On-Line Application
System.
You want to order a study aid or other item. Anyone Write, download the order form from the Give the name and address for delivery of the
website or order online at www.cgfns.org. study aids and enclose the appropriate fee.
You need to tell CGFNS that your on-line roster Only you or your authorized agent E-mail through our website www.cgfns.org State the problem. Include a return phone or
information doesn’t match your initial “Contact Us” , write, or telephone. fax number along with your CGFNS ID number,
notification letter scheduling you for an exam. name and birth date.
You need to tell CGFNS that you are not listed Only you or your authorized agent E-mail through our website www.cgfns.org State the problem. Include a return phone or
on the on-line roster. “Contact Us” , write, or telephone. fax number along with your CGFNS ID number,
name and birth date.
Before you contact CGFNS remember:
1. You will be rostered only after you
received a letter saying you have been
scheduled for the CGFNS Exam.
2. Paper Permits are not sent with the
notification letter.
You want CGFNS to send verification of your Only you Write, or request online at www.cgfns.org via State the request and to whom the letter
certificate status. the On-line Application System and place a should be sent. Include your CGFNS ID number,
CGFNS additional Services order. birth date, signature, and proof of name
change (if applicable) and enclose the
appropriate fee.
You want CGFNS to mail a copy of your nursing Only you Write, or request online at www.cgfns.org via State the request and to whom the letter
education information to a school or U.S. the On-line Application System. should be sent. Include your CGFNS ID number,
board of nursing. birth date, signature, and proof of name
change (if applicable) and enclose the
appropriate fee.
Changing Exam Date or Location Only you E-mail through our website www.cgfns.org Include your Full Name, CGFNS ID number and
“Contact Us”, write or make changes online at date of birth.
www.cgfns.org via the On-Line Application
System.
Legal Name Change Only you Write to CGFNS Request should include signature, CGFNS ID
number, date of birth and legal
documentation of name change.
This Authorization will remain valid for two years from the date written below (or if none, from the date this Authorization is
received by CGFNS/ICHP).
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 within 30 days from the
day that CGFNS/ICHP receives your written revocation by regular mail or courier at its headquarters office in
Philadelphia, PA, USA.
AUTHORIZATION: I authorize CGFNS/ICHP to release to the below-named Authorized Agent any and all
information about me and my application/order for services from CGFNS/ICHP, including 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/ICHP. I understand that all mail (including Certificate, exam scores and reports)
will be sent to the Authorized Agent.
AUTHORIZED AGENT:
Print Contact Name: __________________________________________________________
Print Organization Name: ______________________________________________________
Print Address: ______________________________________________________
______________________________________________________
______________________________________________________
Credit Card Type (check one): CGFNS does not accept American Express Credit Card #:
Visa MasterCard Discover/Novus
Expiration Date: *CVV2 Number
(See explanation on other side.)
Name of Cardholder (as it appears on card):
Total Charges (see “Fee Schedule”): U.S. $
Cardholder Address: (For processing credit card payments only. All Cardholder Signature (authorization for payment):
I hereby authorize a charge to my credit card for the total of all
materials requested will be sent to the applicant address
services requested on the attached Certification Program
provided on the appropriate forms.) Application Form, including any fee adjustments in effect as of
the date the order is received.
X
Signature of Authorized Cardholder
My registration/license number is ______________________ My birth date is: Month __________________ Day ______ Year _______
The registration/license was issued under the name of:
Address
Address – Continued
City
Country
The expiration date of this registration/license is: ______/_______/_______. Birth date of individual: ______/_______/_______
Month Day Year Month Day Year
Print Name
Registration authority title: ____________________________________ Registration
Authority
State/Province and Country: ____________________________________
Seal or Stamp
Must Cover
Please send this document and any Certification Program (CP)
attachments in English.
Signature
CGFNS
Sign your name over the flap after 3600 Market Street, Suite 400
sealing. Send by airmail to: ² Philadelphia, PA 19104-2651, USA
CGFNS Certification Program for Registered Nurses
2007 Application (Required for all applicants)
CGFNS International • 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 U.S.A. • Phone: 215.222.8454 • Web: www.cgfns.org
Provide all information requested below. Failure to respond accurately will delay the processing of your application.
Enter responses clearly. Submit original copy. Retain a copy for your files.
1 Preliminary Information
a. Have you ever applied to take the CGFNS Examination or for any CGFNS/ICHP services? Yes No
2 Your Name
Enter your full, legal name as you would like it to appear on all correspondence and the CGFNS Certification Program Certificate.
Put only one letter in each box.
3 Other Names
List alternate names appearing on your documents. Include legal documentation/proof verifying name change.
4 Birth Date (Spell the month, and enter the day and year of your birth) 5 Gender
City
Country
*Note: You are responsible for notifying CGFNS if your address changes.
City
Country
*Note: You are responsible for notifying CGFNS if your address changes.
9 Your Telephone Number, Mobile (cell phone) Number, FAX Number & E-mail Address
( ) ( ) ( )
Telephone: Include Country Code and/or Area Code Mobile Telephone: Include Country Code and/or Area Code FAX: Country Code and/or Area Code, or TELEX Number
May CGFNS contact you in the future to discuss your experience transitioning to practice in the U.S.? Yes No
May CGFNS send you a text message on your mobile (cell) phone? Yes No
11 Pre-Nursing Education
Please list, in the order you attended, all educational institutions. Explain any gaps in your educational history. If your school has closed
or merged, provide the name and address, if known, where your records are located.
List information for each school attended whether completed or not. Enclose a photocopy of your diploma, certificate, or external exam
certificate from your secondary school, including a word-for-word English translation of each of these documents. External exam results
or school verification of graduation date must be submitted directly to CGFNS by the examining agency or school.
Month/Year Month/Year Name of Diploma or Degree
Name(s) of Schools Attended City, State/Province & Country Entered Completed/ Certificate in its Obtained
Graduated Original Language ()
Primary:
Secondary School:
12 Nursing Education
Please list information for each nursing school attended, whether completed or not. List nursing title in original language.
14 Nursing Experience
Years of full-time nursing experience since graduation from your general nursing program: ________________
Number of years of experience in the following healthcare settings: Hospital _______ Community Health Setting ________
Clinic _______ Specialty Area (name area) ________ Other (name area) ________________________________________________
15 Nursing Registration/License
a. Are you licensed as a nurse in the country in which you received your nursing education? Yes No
b. If yes to question “a”, what is the legal title in the country where you received your general nurse education as it appears on
your diploma or license in the original language? _____________________________________________________________
c. If yes to question “a”, is your nursing license from your country of education active (unexpired)? Yes No
d. If no to question “c”, please list any other countries, states or provinces in which you currently hold a license to practice nursing:
__________________________________________________________________________________________________________
e. Have any of your registration/licenses ever been revoked, suspended or restricted for any reason? Yes No
If yes please explain: _________________________________________________________________________________________
Complete and send a “Request For Validation of Registration/License” form to every registration/licensing authority responsible for
issuing/validating both your initial and current license(s)/registration(s) in your country of education and in the country(ies) where you
hold licenses. The registration/licensing authorities must send the “Request For Validation of Registration/License” form directly to CGFNS.
CGFNS must have a validation for every license you have held, past and present. If your diploma authorizes practice in your country,
forward this form to the institution that issued it (school, Ministry of Health, etc.).
2nd Choice
City/Country Date (Month/Day/Year) Exam Center Number
17 Special Needs
Please attach documentation of your disability, signed by a medical professional. List any special physical equipment or test taking needs
(such as, wheelchair access, large print materials, etc.)
19 Application Fee
Enclose the full application fee in U.S. dollars, drawn on a U.S. bank. Send an international money order or certified bank check
payable to “CGFNS” or pay with a credit card using the Credit Card Payment Form. CGFNS accepts Visa, MasterCard and
Discover/Novus. Personal checks are not accepted. DO NOT SEND CASH. You may also pay on-line using your credit card.
21 Attestation:
Please Note: Each Applicant must sign his/her full name in English characters on the Applicant’s signature line. Attach your
photograph in the designated space.
I certify that all information which CGFNS has received as part of this application 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 it is falsified, altered or tampered with, or if I alter
a CGFNS Certificate or a CGFNS Report or misrepresent a copy as an original, CGFNS may take Attach here one recent
such disciplinary action against me as it deems appropriate including bar me from future passport-size
examinations or from participation in any CGFNS programs. The consequences could photograph of yourself
adversely affect my professional license, immigration status, employment and other matters, with your signature on
from which I release CGFNS from all liability. the front.
I authorize CGFNS to disclose the information and documents in this application, the
status of my CGFNS Certificate, any 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 which CGFNS may determine has a legitimate interest in receiving the same, such as
government agencies or potential employers.
I understand that unauthorized use of test materials, giving or receiving aid during an
examination, or violating instructions at the examination site may be grounds to expel me
from the examination, or bar me from future examinations or from participation in any CGFNS
programs, or to otherwise discipline me as appropriate. Applicants should refuse any requests
by third parties, i.e. friends, recruiters or employers to memorize questions or give them
details regarding the content of the tests. Such activities will result in the applicant’s test
being voided and may prevent them from being eligible for all future exams. In addition, I
authorize the board of nursing of the state in which I take the licensing examination in the
future to release my NCLEX-RN® results to CGFNS for statistical studies. I also agree to send
CGFNS my NCLEX-RN® results.
I understand that the CGFNS Certificate and all copies of it remain the property of CGFNS
and must be returned to CGFNS if CGFNS determines that the holder of the certificate was not
eligible to receive it or that it was otherwise issued in error.
You must sign and date this application in order for it to be processed.
Please mail this Application, the Photo identification Card, your payment and all enclosures to:
CGFNS
Attn: CP Application
3600 Market Street, St 400
Philadelphia, PA 19104-2651
USA
CGFNS International • 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 U.S.A. • Phone: 215.222.8454 • Web: www.cgfns.org
1 Preliminary Information
If you have a CGFNS/ICHP Applicant Identification Number, enter it here.
2 Your Name Enter your full, legal name as you would like for it to appear on all correspondence and the CGFNS CP Certificate.
Put only one letter in each box.
3 Other Names List alternate names appearing on your documents. Include legal documentation/proof verifying name change.
4 Birth Date (Spell the month, and enter the day and year of your birth) 5 Gender 6 Marital Status
Female Married Widowed
Month Day Year Male Divorced Single
7 Your Permanent Address *Note: You are responsible for notifying CGFNS if your address changes.
Indicate the address at which you reside. Include your telephone, fax and e-mail where you wish to be contacted.
City
Country
( ) ( )
Telephone: Include Country Code and/or Area Code FAX: Country Code and/or Area Code, or TELEX Number E-mail: (example: [email protected])
8 Nursing Education
Please list information for each nursing school attended, whether completed or not. List nursing title in original language.
Month/Year Month/Year Nursing Title Obtained Degree
Name(s) of Schools Attended City, State/Province & Country Entered Completed/ in home Country in its Obtained
Graduated original language ()
9 Applicant Signature
Sign Entire Name (Do Not Print) This authorizes release of your academic transcripts/records to CGFNS.
Country
FAX Number E-Mail Address
Did this applicant attend a first-level, general nursing program? □ Yes □ No (If “no,” specify the type of program.)
What were the total years of formal schooling the applicant received before attending your nursing school?
Please fully complete the chart below. This information is required for our evaluation. Please provide specific hours of theoretical instruction
and number of 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. Please attach a copy of the
actual transcript. Both the completed form and the educational transcript must be sent directly to CGFNS. All documents must be in English.
(Print Name)
(Title)
(Date)
3. NAME:
4.
5. SIGNATURE OF APPLICANT:
Do Not Print – Sign Entire Name – (First Name, Middle, Last/Family Name)