Foreign Nursing Education Verification Form

Foreign Nursing Education Verification Form
Use this form to submit nursing education details for verification of foreign academic and credential records.
Applicant Information
Full Name
First NameMiddle NameLast Name
Preferred Name
Date of Birth
MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Country of Residence
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Foreign Nursing Education Details
Name of Nursing School or Institution
Country of Education
City / State / Province of Institution
Nursing Program Name
Degree or Credential Earned
Field of Study
Dates of Attendance
MonthDayYear
Date
Graduation Date
MonthDayYear
Date
Language of Instruction
Licensure and Academic Verification
Did the applicant obtain nursing licensure or registration in the country where the education was completed?
Licensure or registration status
Issuing authority or board name
Document Uploads and Supporting Evidence
Transcript
Cancelof
Diploma or Certificate
Cancelof
Course Syllabus or Curriculum Summary
Cancelof
Credential Evaluation Report
Cancelof
Verifier / Institution Contact Details
Verifier Name
First NameMiddle NameLast Name
Title / Role
Institution / Organization Name
Official Email
example@example.com
Official Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Should be Empty: