CGFNS Credentials Evaluation Service 2008 Edition

The CGFNS Credentials Evaluation Service (CES) is a prerequisite

for state licensure of internationally-educated registered nurses
and licensed practical nurses in certain U.S. states and territories.
It is also utilized by U.S. academic institutions and prospective
employers to assess the international education of healthcare
professionals who wish to continue their education in the U.S.
or want to be employed in the U.S.
The Credentials Evaluation Service results in a written report
regarding the applicant's education and professional licensure
or registration credentials. Some organizations require the
Healthcare Profession & Science Course-by-Course Report.
Other organizations require the Full Education Course-by-
Course Report. Applicants will need to designate which
Report is required by the receiving organization.
CGFNS has issued more than 35,000 Credentials
Evaluation Service reports for internationally-educated
healthcare professionals during the past 14 years.
Applicant Handbook
A prerequisite for state licensure of
internationally-educated:
registered nurses
licensed practical nurses
midwifery
in certain U.S. states and territories.
It is also utilized by U.S. academic
institutions and prospective
employers for the purpose of
assessing the international education
of healthcare professionals

Table of Contents
Introduction to CGFNS Credentials Evaluation Service .............................................................................................................................................. 2
Choose From Two Types of Reports ...................................................................................................................................................... 2
What This Handbook Contains ................................................................................................................................................................................ 2
Chart 1: Overview of the Steps to Receive a CGFNS Credentials Evaluation Service Report ...................................................... 3
How to Apply .......................................................................................................................................................................................................... 3
How to Complete the Application ............................................................................................................................................................................ 3
Chart 2: Checklist To Prevent Common Application Form Problems ............................................................................................ 6
Preparation and Mailing of Academic Records Form ................................................................................................................................................ 6
Preparation and Mailing of Validation of Registration/License Form ........................................................................................................................ 6
Falsified or Altered Documents ................................................................................................................................................................................ 7
Changing Your Name or Address .............................................................................................................................................................................. 7
Re-Process an Application........................................................................................................................................................................................ 7
Guidelines for Communicating with CGFNS .............................................................................................................................................................. 7
World Wide Web........................................................................................................................................................................................ 7
Authorization to Release Information Form.......................................................................................................................................... 7
Email ............................................................................................................................................................................................................ 7
Letters .......................................................................................................................................................................................................... 7
On-site Appointments .............................................................................................................................................................................. 7
Telephone Calls .......................................................................................................................................................................................... 8
In the Event of a Disaster .......................................................................................................................................................................... 8
Chart 3: Communication Guidelines ...................................................................................................................................................... 8
Request for Academic Records Form ........................................................................................................................................................................ 9
Request for Validation of Registration/License Form ................................................................................................................................................ 10
Authorization to Release Information Form ............................................................................................................................................................ 11
Credit Card Payment Form ...................................................................................................................................................................................... 12
Application Form For CGFNS Credentials Evaluation Service ...................................................................................................................................... 13
Introduction to CGFNS Credentials Evaluation Service
The Commission on Graduates of Foreign Nursing Schools (CGFNS International) Credentials Evaluation Service (CES) analyzes
the credentials of various types of nursing-related professionals educated and licensed outside of the United States who wish to work
or study in the United States. The Credentials Evaluation Service Report helps qualified healthcare professionals demonstrate the
merits of their credentials with regard to U.S. standards.
Many organizations in the United States require a credentials evaluation to help them understand educational and professional
credentials earned outside of the country and to make appropriate assessments. Approximately one-half of the U.S. state boards of
nursing require CES Reports for foreign applicants seeking initial and endorsement licensure in their state.
The CES Report analyzes the education and licensure earned outside of the United States by nursing-related professionals and
compares this to U.S. standards. In this objective evaluation, CGFNS carefully assesses the documents received from source
agencies. The CGFNS Credentials Evaluation Service (CES) Report is advisory in nature and does not make specific placement
recommendations. This service does not include an examination. After all required documentation, fees, and a completed
application are received and analyzed, CGFNS prepares a report and sends it to the recipient(s) that the applicant designates. The
applicant will also receive a copy of the report.
Choose From Two Types of Reports
CGFNS currently offers two types of CES reports. Contact the organization (the recipient) that asked to receive your CES Report
to find out which type of report is required. The two types of reports are described below:
Healthcare Profession & Science Report This report gives general information about the education and professional
registration/license 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 send your CES
Report to the requested recipient(s), we will attach a copy of your healthcare academic records.
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 types of CES Reports contain an analysis of secondary and professional education, country-specific background information
about schools attended by the applicant, complete dates of attendance, validations or registration/license information received
directly from source authorities, and bibliographical references. All information is explained in terms of U.S. standards. CGFNS may
choose to evaluate only the materials that it considers relevant to the CES Review.
What This Handbook Contains
1. Information on the Credentials Evaluation Service Program and process.
2. Instructions for completing:
The Application for Credentials Evaluation
The Request for Academic Records form, and
The Request for Validation of Registration/License form
3. Guidelines for communicating with CGFNS
4. Authorization to Release information
5. The Application, Request for Academic Records for Credentials Evaluation, Request for Validation of Registration/License for
Credentials Evaluation, and a form for optional payment by credit card.
The CGFNS Credentials Evaluation Service Applicant Handbook describes how to apply for and receive a Credentials Evaluation
Service Report. There are many steps (see Chart 1). Please read this entire booklet before completing any of the application forms.
The detailed description of each step will help you to understand the complete program.
CGFNS processes all applications at its headquarters in Philadelphia, PA, USA. If you have any questions or concerns as you
proceed through the CGFNS Credentials Evaluation Service, please contact the CGFNS Customer Service Department. Refer to
page 7 for guidelines on communicating with CGFNS. For more information on CGFNS and its services, please visit our website at
www.cgfns.org.
2 CGFNS Credentials Evaluation Service Applicant Handbook
All steps must be completed successfully.
How to Apply
The most convenient way for you to apply is online at www.cgfns.org. Completing the application online may speed up your
application process. You can download a printable version of the Application for the CGFNS Credentials Evaluation Service at
www.cgfns.org. You can also find an application form in the back of this handbook. Please follow the instructions exactly and
completely.
How to Complete the Application
Item 1.
A. Indicate how you learned about CES.
B. Indicate why you selected CGFNS to prepare your evaluation.
C. Indicate the title of your profession
D. Indicate whether you have previously taken and passed the NCLEX-RN/LPN exam
Item 2. Preliminary Information
If you have previously applied to CGFNS/ICHP for another service, fill in your CGFNS/ICHP ID number in the boxes provided.
Fill in the name of the state or states where you plan to practice.
Fill in the name of the country where you worked, your profession and the number of years you worked in this profession.
Item 3. Your Name
List your name on the CES application form as you would like it to appear on your Credentials Evaluation Service Report.
Item 4. Other Names
Please supply all names you have used in the past. This is necessary because CGFNS must be able to recognize all your documents,
no matter what form of your name appears on them. Any variation of your 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
with your application any legal documentation or notarized affidavit(s) verifying your name change. For instance, if married, a
marriage certificate or notarized affidavit should be attached.
Item 5. Addresses
a Enter the address where you reside.
b. Enter the address where you want to receive all mail from CGFNS. If you authorize someone else to receive your mailings from
CGFNS, all correspondence will go to that persons address.
If your address changes at any time during the application process, you must notify CGFNS in writing (e-mail will not be accepted);
or, make changes to your contact information on the CGFNS On-Line Application System at www.cgfns.org.
CGFNS Credentials Evaluation Service Applicant Handbook 3
Chart 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 a CES Application Form and send it with full payment to CGFNS. CGFNS sends you an identification number.
Prepare and send the Request for Validation of Registration/License Form to your initial
licensing authority and all other licensing authorities outside of the U.S. who have issued you
licenses/registrations, asking them to send us your records.
CGFNS reviews all registrations/licenses and validates that they come from the issuing
source.
Check your status online at www.cgfns.org or through the automated phone system
(215) 599-6200 using your CGFNS identification number and date of birth. Respond to any
correspondence from CGFNS regarding missing items.
After CGFNS receives and evaluates all of the required documentation, we issue a report to
the designated recipient. We also send you, the applicant, a copy of the report.
Prepare and send the Request for Academic Records Form to any nursing or nursing-related
post-secondary schools that you attended outside the United States, asking them to send
your records to CGFNS.
Send us a photocopy of your secondary school certificate/diploma.
CGFNS reviews all academic records that we receive from your healthcare or post-secondary
schools. Then we match them against our global database to find information about the
specific school and grading system.
Item 6. Current Marital Status
Enter your marital status.
Item 7. Birth Date
Enter the month, day and year of your birth. The month should be spelled out and not listed as a number.
Item 8. Gender
Enter whether you are male or female.
Item 9. Citizenship
Please list your country of birth and country of current citizenship. Please provide a citizenship identification number or
identification number from country of birth, if applicable. Also list your native language and the country in which you received your
initial professional education.
Item 10. 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.
Item 11. U.S. Social Security Number
The U.S. Social Security Number is an identification number issued by the U.S. Government. Please enter this number, if known.
Item 12. Education
Please list all primary, secondary, professional nursing related and professional non-nursing related educational institutions that you
attended, the countries in which the schools were located, and dates of attendance (month/year). Include all schools, whether you
completed the program of study or not, beginning with your primary school then secondary school and professional healthcare
school. Check whether or not your education resulted in a degree. Explain any gaps in your educational history.
Send a copy of the Request for Academic Records Form to each school listed. CGFNS can only accept the transcript from the
authorized issuing body.
Secondary School Diploma
Include a clear copy of your secondary school credential. Examples of this would be: a secondary school diploma, results of an
external exam, or General Education Development (GED) certificate.
Diploma Not in English
If your diploma or certificate is not in English, you must attach a literal English translation, not a summary. The following
sentence, referred to as a 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. Transcripts from secondary schools do not need to be translated by an official
translator.
Unable to Obtain a Copy of Your Diploma
If you cannot obtain a copy of your diploma, you may request that your secondary school send a letter directly to CGFNS,
confirming your dates of attendance and date of graduation. If you cannot obtain a copy of your certificate that was awarded
based on the results of an external exam (for example, GCE, GCSE, Irish Leaving Certificate, WAEC), you may ask the examining
board to send a letter directly to CGFNS certifying the grade(s) earned on the examination(s).
Letters submitted by a secondary school or examining board must be written on official stationery; be signed by a school
principal; headmaster or an examining board official; and, contain the schools or examining boards stamp or seal. If the letter is
not in English, include a literal translation with a Certificate of Accuracy signed by the translator.
4 CGFNS Credentials Evaluation Service Applicant Handbook
Example of 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 [applicants name].
Form V
Applicants educated in countries where completion of Form V is considered completion of secondary school, may submit one
of the following documents as verification:
statement of completion of Form V issued by the headmaster or school principal
official secondary school transcript showing completion of Form V, or
external examination results
Item 13. Registration/License
a. Check the appropriate box if you are not currently registered/licensed and explain.
b. Please list your legal professional title(s) and country(ies) where your title(s) are registered/licensed.
c. List the state(s)/province(s)/country(ies) where you hold a current registration/license as a healthcare professional.
d. Indicate whether your registration/license has ever been revoked, suspended or restricted. Be sure to answer this question for all
registration/licenses that you hold now and have held in the past.
Failure to answer the questions in Item 13 will result in a delay in evaluating your application.
Items 14a, 14b, 14c, 14d, 14e, 14f. Report Recipients
List the names and addresses of one or two recipients for your CES Report. This would include a state board of nursing, an
educational institution, or a potential employer. For each recipient, indicate the type of report and purpose of the request. You
automatically receive a copy of the report. It is not necessary to list yourself. Please note the CES report is used by U.S. institutions.
If you are selecting an international recipient please provide a written explanation.
Item 15. Application Fee
The Application fee can be paid by:
Credit card CGFNS accepts Visa, MasterCard and Discover/Novus (CGFNS does not accept American Express).
International money orders or certified bank checks made payable to CGFNS.
Personal checks are not accepted.
All fees must be paid in U.S. dollars drawn on a U.S. bank.
Before your file can be reviewed, we must receive the full application fee as determined by the number of items entered in this
section. Note that any money submitted to CGFNS/ICHP will first be applied to any unpaid balance from previously ordered
products or services before new orders are processed.
The fees cover the expense of processing your application, reviewing your credentials, preparing the CES Report and postage.
Applications remain open for 12 months. Applicants who do not meet the requirements of the CES program within the first 12
months of their order may continue the service by applying for Re-Process and paying the associated fee.
Item 16. Terms and Conditions of the CES Application
This is a summary of the responsibilities of the applicant and CGFNS.
Item 17. Attestation
The attestation in Item 17 creates a contract between you and CGFNS. It explains the terms under which CGFNS will process your
application. After reading it carefully, sign and date the form. 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 CGFNS Credentials Evaluation Service Report or misrepresent a copy as an original,
CGFNS may take any disciplinary 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.
Signature
Sign the Application Form with the same name you indicated in Item 3 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. The resulting CGFNS Credentials
Evaluation Report will be issued using the name provided on your application. The Application Form does not need to be notarized.
CGFNS Credentials Evaluation Service Applicant Handbook 5
If You Choose to Mail Your Application
After completing your Application Form, send it to CGFNS, along with a photocopy of your secondary school diploma, and all
required fees. Send your application materials to the following address:
CGFNS
Attn: CES Application
3600 Market Street, Suite 400
Philadelphia, PA 19104-2651 USA
CGFNS does not return any of the documents that are part of your complete application.
Remember to send readable photocopies, not originals, of the documents CGFNS requests directly from you. Applications
remain open for one year (12 months).
Preparation and Mailing of Academic Records Form
To give CGFNS the necessary information about your education, you will need to send one copy of the Request for Academic
Records form to each healthcare or post-secondary school that you attended outside the United States to ask them to send us your
academic records. Provide all of the requested information on the front (the applicant's side) of the form before sending the form to
each school that you attended. Enclose any payment that your school(s) may require (including translation costs).
IMPORTANT: We must receive all of your nursing-related academic records directly from your school(s). We cannot accept
records supplied by you or anyone else other than the school. If we receive foreign-language documents without an English
translation, we can have them translated for the fee stated on the fee schedule, at your request.
Preparation and Mailing of Validation of Registration/License Form
You must request validations for your current and initial registrations/licenses obtained outside the U.S. To do this, use the Request
for Validation of Registration/License for Credentials Evaluation Service form included in this applicant handbook. If you need to
validate more than one registration or license credential, make photocopies of the blank form. Complete the front of the form (the
applicant's side) and mail it to the authority that issued your registration or license. The section titled For Registration Authority
Use Only is to be completed by your licensing agency. 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. Further information may be required after your file is initially
reviewed.
Additional Requirements for New Jersey and Michigan
The New Jersey Board of nursing requires proof that the applicant has achieved a passing score on the English Proficiency
Examination required by the Department of Homeland Security for certification of healthcare 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 program that was 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.
6 CGFNS Credentials Evaluation Service Applicant Handbook
Chart 2: Checklist To Prevent Common Application Form Problems
Check Each Item Below to Ensure that You Avoid Common Application Problems
Before mailing your application, check to see that you have:
entered a response to every item
included, in Item 4, every form of your name that appears on your application documents and any necessary proof of your other names
completed the enclosed Request for Academic Records Forms and sent them to the appropriate education institutions (see page 6)
completed the enclosed Request for Validation of Registration/License Forms and sent them to the appropriate licensing authorities (see page 6)
every document is either in English or has a literal English translation attached that includes a Certificate of Accuracy, signed by the translator (see page 4)
signed the application
included credit card payment, international money order or certified bank check for the full application fee in U.S. dollars, drawn on a U.S. bank, payable to
CGFNS. DO NOT SEND CASH.
Falsified or Altered Documents
If CGFNS finds that your documents have been altered in any way or that information in your application is false, whether
submitted by you or on your behalf by another person, CGFNS will not issue a Credentials Evaluation Service Report on your
behalf. Therefore, before anything is sent to CGFNS make certain that none of the material has been falsified or altered in any way.
Submitting falsified or altered documents will result in your file being closed, loss of your entire application fee and ineligibility for
future CGFNS/ICHP services.
Changing Your Name or Address
If you have changed your legal name, CGFNS can make the change in your application file when we receive your signed, written
request with legal proof of name change. Requests to change your mailing address must be in writing or you may make the change
online through the CGFNS website. In your letter requesting any of these changes, remember to include your CGFNS ID Number
and birth date. E-mail requests for change of name and address will not be accepted at any time.
Re-Process an Application
Applicants applying for the Credentials Evaluation Service will be given 12 months to meet the requirements of the program. Orders
for the Credentials Evaluation Service that have not resulted in the issuing of a Credentials Evaluation Service report within 12
months of the application date will be expired. Once an order is expired, an applicant can re-apply with a re-process application and
pay a second year re-process an expired order fee. Re-process orders remain open for 12 months starting from the date the re-process
order is placed. A re-process order cannot be placed until the previous order is expired.
Guidelines for Communicating with CGFNS
If you have questions about your application or required documents, we recommend that you first go to the CGFNS website,
www.cgfns.org to check the status of your account, or you may access your account through our Automated Phone System
(215) 599-6200. You may also contact CGFNS via letter, telephone, or through our website at www.cgfns.org Contact us. We offer the
following guidelines to make this communication easier (see Chart 3 on page 8 for additional information).
World Wide Web
You may access the CGFNS website for information on CGFNS and its programs, services and activities, application forms, and the
On-line Application System at www.cgfns.org. To login and check your status, you must create a username and password.
Authorization to Release Information Form
If you want someone else to be able to access information from your confidential files, you must complete an Authorization to
Release Information form and return the completed form to CGFNS. We will not release information to anyone other than the
applicant without an Authorization form. You can revoke this authorization in writing at any time by sending CGFNS a signed letter
stating that you revoke the Authorization. Authorization to Release Information forms are available on CGFNSs website at
www.cgfns.org or on page 11 of this Handbook.
E-mail
Applicants may contact the CGFNS Customer Service Department with questions regarding their application by e-mail at
www.cgfns.orgContact us.
Letters
CGFNS treats your application as confidential, to be discussed only with you unless you have named an authorized agent. 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 birth date. 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 applicants file by scheduling a 30-minute appointment
in our CGFNS office in Philadelphia, PA. Appointments are available Monday through Friday between 100:00 a.m. - 3:30 p.m.
(Eastern Standard Time in the United States) and may be made by calling the office at 215-222-8454
CGFNS Credentials Evaluation Service Applicant Handbook 7
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, 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 Standard 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.
In the Event of a Disaster
CGFNS makes every effort to ensure that our communication with applicants is clear and timely. However, some events are out of
our control. Events such as natural disasters, political unrest and postal strikes may occasionally affect the application process.
CGFNS cannot be responsible for delays caused by such conditions, but we will make every reasonable effort to notify you of any
alternate arrangements.
8 CGFNS Credentials Evaluation Service Applicant Handbook
Chart 3: Communication Guidelines
Reasons for Communication Who Can Initiate Request? Communication Channel Special Tips
You wish to obtain copies of the CGFNS
Credentials Evaluation Applicant Handbook.
Anyone. E-mail through our website www.cgfns.org
Contact Us , write, telephone or download
from the web site.
An individual can receive 1 CES handbook free
of charge by mail. If ordering additional
copies, the fee (and any shipping costs) must
be pre-paid.
You want to confirm whether CGFNS received
your application documents.
Only you or your authorized agent. E-mail through our website www.cgfns.org
Contact Us, write, telephone, or visit the
On-line Application System (CGFNS Connect)
at www.cgfns.org.
Include your Full Name, CGFNS/ICHP
ID number and date of birth.
You have a question about a letter that you
received from CGFNS/ICHP.
Only you or your authorized agent. E-mail through our website www.cgfns.org
Contact Us , write or telephone.
Include your Full Name, CGFNS/ICHP
ID number and date of birth.
You need to notify CGFNS of a change of
address.
Only you or your authorized agent. E-mail through our website www.cgfns.org
Contact Us, write, or make changes online at
www.cgfns.org via the On-Line Application
System (CGFNS Connect).
Include your Full Name, CGFNS/ICHP
ID number and date of birth.
Legal name change Only you Write to CGFNS including legal documenation
of name change
Request should include signature, full name,
CGFNS/ICHP ID number ID number and date
of birth.
Dear Registrar:
Please promptly complete the lower part of this formand send it to the Commission on Graduates of Foreign Nursing Schools (CGFNS International)
along with my academic record(s) listing the courses taken, hours of study, clinical practice hours and grades earned, accompanied by a certified English
translation.
My current name is: (Print or type your current name)
I attended (name of school) _________________________________ between (dates of attendance) ________/_______ and _________/______
My birth date is: Month (spell out) ______________________________ Day _________ Year _________
The name I used when I attended your school was: (Print or type the names you used when attending this school)
My CGFNS ID# (if known) is:
My Order# (if known) is: ___________________ Applicant Signature ____________________________________________
My current address is:
Telephone Number Fax Number E-mail Address
Request For Academic Records For Credentials Evaluation Service
Address
Address Continued
City
Country
First Name Middle Name Last Name
First Name Middle Name Last Name
Month / Year Month / Year
Subjects Hours of Theoretical Instruction* Hours of Clinical Practice
Care of the Adult Medical Nursing
Care of the Adult Surgical Nursing
Maternal/Infant Nursing, excluding Gynecology
Nursing Care of Children
Psychiatric/Mental Health Nursing, excluding Neurology
Gerontology Nursing
Pharmacology
Physiology
Psychology
Sociology
Anatomy
Nutrition
* Includes hours of classroom education, laboratory, and planned clinical conferences (ward teaching)
School Seal or
Stamp Must
Cover Signature
Credentials Evaluation Service
CGFNS
3600 Market Street, Suite 400
Philadelphia, PA 19104-2651, USA
Sign and Print entire name, title and date
Please place school seal or stamp over
flap of envelope after sealing and return
the transcript/academic record(s) ALONG
WITH THIS FORMvia airmail to:

Signature _________________________________________________________________
FOR NURSES ONLY: In addition to a copy of the transcript, 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. All documents must be in English.
FOR SCHOOL USE ONLY:
What is the applicants birthday? Mo._________ Day ______ Yr_____ Admission or start date of program Mo.__________ Day _____ Yr______
What was the language of instruction for this applicant?____________________
What was the textbook language for the applicants program/course of study? _____________________________
Type of program (i.e. diploma, baccalaureate, midwifery) __________________________
Is your school a government-approved school? Yes No
I hereby attest that the enclosed Academic Record
accurately states courses taken, hours of study,
and grades received for the above-named individual.
Date of program completion Mo._________ Day _____ Yr______
State/Province Postal/Zip Code
(Applicants to complete this side)
FOR REGISTRATION AUTHORITY USE ONLY:
1. This is to certify that ________________________________________________________ was first issued registration/license/diploma
number ____________ to practice as a ___________________________________________________ on: ______
/
_______
/
_______.
The expiration date of this registration/license is: ______
/
_______
/
_______. Birth date of individual: ______
/
_______
/
_______
2. Authority to Practice:
National/Provincial/State Examination
Review of another license (endorsement)
Registration Diploma
Other: __________________________
4. Name and location of professional education program completed: ______________________________________________________
5. Date of graduation: ______
/
_______
/
_______
6. Professional education program accredited/government approved? Yes No By Whom? ________________________________
7. Type of Program: Diploma Baccalaureate Degree
Associate Degree Other (specify) ___________________________________
8. Signature of registration authority Date: _______
/
_______
/
_______
(Do not print)
Sign and Print entire name
Registration authority title: ____________________________________
State/Province and Country: _______________________________________
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
(Specify legal title)
(Applicant Name)
Please send this document and any
attachments in English, in the
enclosed envelope. Sign your name
over the flap after sealing. Send via
airmail to:

3. Status
Active/Current Expired
Inactive Restricted*
*Please attach an explanation if
the applicants registration/
license/diploma has ever been
revoked, suspended, limited, or
placed on probation.
Registration
Authority
Seal or Stamp
Must Cover
Signature
Credentials Evaluation Service
CGFNS
3600 Market Street, Suite 400
Philadelphia, PA 19104-2651, USA
Dear Registration Authority:
Please promptly complete the other side of this formand send it to the Commission on Graduates of Foreign Nursing Schools (CGFNS International)
as validation of my professional registration/license, accompanied by a certified English translation.
My current name is:
My registration/license number is ______________________ My birth date is: Month __________________ Day ______ Year _______
The registration/license was issued under the name of:
My CGFNS ID# (if known) is:
My Order# (if known) is: ___________________ Applicant Signature ____________________________________________
My current address is:
Country
Address
Address Continued
City
State/Province Postal/Zip Code
First Name Middle Name Last Name
First Name Middle Name Last Name
Telephone Number Fax Number E-Mail Address
(Required for all Applicants)
Request forValidation of Registration/License For Credentials Evaluation Service
AUTHORIZATION TO RELEASE INFORMATION
NOTICE: By signing below you: (1) allow CGFNS/ICHP to disclose confidential, personal, private information about you and your
file at CGFNS/ICHP to the person designated below; (2) give up the right to receive information from CGFNS/ICHP directly; and
(3) release and indemnify CGFNS/ICHP, its members, trustees, officers and employees from any liability for losses, damages or claims
of any type arising out of actions taken by CGFNS/ICHP in reliance upon this Authorization.
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.
This Authorization revokes all previous Authorizations submitted by the applicant.
CGFNS/ICHP ID No.___________________ (if known)
Date of Birth: _________________________ (M/D/YR)
Sign name as it appears on your Application/Order:__________________________________
Print name: ________________________________________
Date: ____________________________ (M/D/YR)
AUTHORIZED AGENT:
Note: This form is not for report recipients. Report recipients, for example, State Boards of Nursing, are listed in Section 14 of the application.
Print Contact Name: __________________________________________________________
Print Organization Name: ______________________________________________________
Print Address: ______________________________________________________
______________________________________________________
______________________________________________________
Telephone: Day: ___________________________ Fax number: ______________________
Evening: ________________________ E-mail: __________________________
3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 U.S.A.
Phone: 215.222.8454 Web: www.cgfns.org
Credit Card Type (check one): CGFNS does not accept American Express
Visa MasterCard Discover/Novus
Name of Cardholder (as it appears on card):
Cardholder Address: (For processing credit card payments only. All
materials requested will be sent to the applicant address
provided on the appropriate forms.)
Credit Card #:
Expiration Date: *CVV2 Number
Total Charges (see Fee Schedule): U.S. $
Cardholder Signature (authorization for payment):
I hereby authorize a charge to my credit card for the total of all
services requested on the attached Certification Program
Application Form, including any fee adjustments in effect as of
the date the order is received.
X
(See explanation on other side.)
Signature of Authorized Cardholder
3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 U.S.A.
Phone: 215.222.8454 Web: www.cgfns.org
Credit Card Payment Form:
To pay by credit card, please fill in your full name (as it appears on this application) and your CGFNS/ICHP Applicant ID Number (if known)
below. Complete the cardholder information requested on the other side. Detach this form only if payment is being made by a third party.
Name of Applicant:
CGFNS/ICHP Applicant Identification Number
(if known)
Applicants Date of Birth:
Day Month Year
*Explanation of Credit Card CVV2 Number:
( To be entered below)
Visa and MasterCard: This
number is printed on your
MasterCard & Visa cards in
the signature area of the card.
(It is the last 3 digits AFTER the
credit card number in the
signature area of the card).
If you already have a CGFNS/ICHP Identification Number, enter it here. Order # (if known) __________
A. Intended U.S. State(s) of practice _____________________________ .
B. I worked in ________________________________ as a __________________________________ for _______ years.
City/Country Profession Specialty Number
Please assist us by answering two brief questions. Your cooperation will aid us in serving you better in the future.
A. How did you learn of CGFNS/ICHPs Credentials Evaluation Service?

U.S. College/University

State Licensure Board

Recruiter

U.S. Employer

Immigration Attorney

CGFNS mailed you information

Other (Please explain) ___________________________________________________

B. Why did you select CGFNS/ICHP over another organization for your Credentials Evaluation Services?

Instructed by your report recipients

We sent you (or you requested) an application

Price

CGFNS reputation

Other (Please explain)___________________________________________________________________________________

C. Title of your profession _____________________________________________________________________________________
D. Have you previously taken and passed the NCLEX-RNor LPN exam? Yes No
Country of Birth ____________________________________ State/Province _____________________________
Citizenship ID Number_________________________ Native Language _________________________________
Current Citizenship __________________ Country of Initial Professional Education____________________
First and Middle Names (Leave a space between names)
Last (Family) Name (Leave a space between names)
Name Before Marriage
Other Names (for married women only)
Street Address/ Post Office Box Number
Address - Continued
City
Postal/Zip Code Country

Single (Never Married)

Married

Divorced

Widowed
Enter your full, legal name as you would like it to appear on the report. Print or type only one letter in each box.
Enter alternate names appearing in your documents. Include legal documentation verifying
each name change (for example: marriage certificate).
Indicate the address where you reside.
Day Year
Month
State/Province
1 Our Commitment
to Service
2 Preliminary
Information
3 Your Name
4 Your Other Names
(if applicable)
5a Permanent
Address
6 Current
Marital Status
7 Your Birth Date
Spell the month, enter
day and year of birth.
8 Gender

Female

Male
9 Citizenship
Street Address/ Post Office Box Number
Address - Continued
City
Postal/Zip Code Country
Provide the address where you want to receive your mail.
State/Province
5b Mailing Address
CGFNS International 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 U.S.A. Phone: 215.222.8454 Web: www.cgfns.org
Credentials Evaluation Service
2008 Application (Required for all applicants)
Please provide the following information.
A. If you are not currently registered/licensed, please indicate and explain.
Not currently registered/licensed Never registered/licensed
Explanation: _____________________________________________________________________________________________
________________________________________________________________________________________________________
B. List your legal professional title(s) and country(ies) where you are currently licensed or have held a license.
________________________________________________________________________________________________________
C. List the state(s)/province(s)/country(ies) where you have ever held registration/license as a healthcare professional.
_________________________________________________________________________________________________________
D. Have any of your registrations/licenses ever been revoked, suspended or restricted for any reason?
Yes No If Yes, please attach an explanation to your application.
Name of Non-healthcare Schools Attended City & Country Month/Year
Entered
Month/Year
Completed/
Graduated
Name of Diploma or
Certificate in its
Original Language
Please list, in the order you attended them, all professional healthcare educational institutions. Explain any gaps in your
educational history.
Indicate here the names and addresses of as many as two different recipients for your report. For each recipient, indicate the type
of report and purpose of the request. NOTE: It is not necessary to list yourself; you automatically receive a copy of the report.
Name and
Address of the
First Recipient
of Your Report
Address/Post Office Box Number
Address - Continued
City
State/Province Postal/Zip Code
Country
Name of Organization
Name of Contact Person or Title
Pre-healthcare Profession
Education
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
word-for-word English
translations of each of these
documents. External exam
results or school verification of
graduation date must be
submitted directly to CGFNS/
ICHP by the examining
agency or school.
Healthcare Education
List information for each
school attended whether
completed or not. Forward a
copy of Request for
Academic Records Form to
each school listed here.
Primary:
Intermediate
Secondary:
Post-secondary non-professional programs:
Phone: Include Country Code/Area Code E-Mail Address (example: name@usenet.com)
( )

FAX: Include Country Code/Area Code
( )
Mobile (cell) : Include Country Code/Area Code
( )
12 Institutions
Attended
Degree
Obtained
( )
Name of Professional
Healthcare Schools Attended
City, State/Province,
Country
Month/Year
Entered
Month/Year
Completed/
Graduated
Name of Diploma or
Certificate in its
Original Language
Degree
Obtained
( )
Title
Obtained
14a Report
Recipients
13 Registration/
License
Forward a copy of Request for
Validation of Registration/
License Form to the authority
where you were initially
registered/licensed and to all
authority(ies) where you are
currently registered/licensed
outside of the U.S.
10 Your Telephone,
Mobile (cell phone),
& FAX Numbers
and E-mail Address
(if available)
May CGFNS send you a text message on your mobile (cell) phone? Yes No
What is your preferred method of communication from CGFNS? Mail Email
11 Your U.S. Social
Security Number
Fill in your Social Security
Number (if you have one)
Please list, in the order you attended them, all non-healthcare educational institutions, beginning with the first year of your
primary school education and ending with the last year of non-healthcare education. Explain any gaps in your educational
history. (Please fill in all spaces in the charts below completely or your application will be returned to you.) If your school has
closed or merged, provide the name and address, if known, where your records are located.
Has your nursing school closed or merged with another school? Yes No If Yes, Name of School ______________________
Ed. 32/08 2008 CGFNS. All rights reserved.
First Recipient (continued)
RN Licensure LPN Licensure Academic Admission
Employment Immigration Certification Other ________________________
RN Licensure LPN Licensure Licensure Endorsement Academic Admission

Employment

Immigration

Certification

Other ________________________
Healthcare Profession & Science Report Full Education Course-By-Course Report
Select only one type of report. If you are requesting that two different types of reports be issued to two recipients, you should pay for
the most detailed report requested. Please confirm the type of report needed with your recipient(s).
Check

here to indicate selection. Refer to Fee insert for current year.

Healthcare Profession & Science Report.....................................................................$_______

Full Education Course-By-Course Report ...................................................................$_______

CGFNS Language Report: English .................................................................................$_______

Other CES Services (refer to fee schedule).................................................................$_______ $___________

Use This Column to
Compute Total Fees Due
Refer to page 1 of Application Handbook for an explanation of both CES Reports.
Healthcare Profession & Science Report Full Education Course-By-Course Report
Full payment for all services requested must be included with your application. Send only a certified bank check or international
money order, drawn in U.S. dollars on a U.S. bank, and made payable to CGFNS, or pay by credit card using the Credit Card
Payment Form, or pay on-line at www.cgfns.org. Personal checks are not accepted.
= $___________
14b Type of Report
14c Purpose of
This Report
Indicate here the name and address of the Second recipient for your report. Indicate the type of report and purpose of the request.
Address/Post Office Box Number
Address - Continued
City
State/Province Postal/Zip Code
Country
Name of Organization
Name of Contact Person or Title
14d Name & Address
of the Second
Recipient of Your
Report
(if applicable)
14e Type of Report
14f Purpose of
This Report
15a Credentials
Evaluation
Report Fees
15b Total
Application Fee
The following clarifies the obligations of the provider (CGFNS/ICHP) and applicant (you) of the Credentials Evaluation
Service, as well as the manner in which this service is delivered.
CGFNS may choose to evaluate only the materials that it considers relevant to the CES Review.
All documents submitted, including transcripts, become the property of CGFNS and cannot be returned to you. Do not
send originals of diplomas, degrees, certificates, registrations or licenses.
If your application includes any forged, altered or falsified documents or information, CGFNS will not prepare an
evaluation report and no refund will be issued.
No evaluation is performed until CGFNS receives full payment. Please calculate the payment correctly and include it
with each application or request. See Fee Schedule.
The CES Report is valid only when the official (embossed) CGFNS seal is affixed.
State Boards of Nursing access CES reports online. All CES Reports to applicants and to non-State Board
of Nursing recipients are sent via First Class mail (within the U.S.) or airmail (outside of the U.S.).
Fees as published with this application may change without notice.
Any payment sent to CGFNS will be applied first to any unpaid balance from a previous order for product or services
before it is applied as payment for a newer order.
No refund is given after an application is submitted.
Applications remain open for 12 months. Applicants who do not meet the requirements of the CES program
within the first 12 months of their order may continue the service by applying for Re-Process and paying
the associated fee.
16 Terms and
Conditions of
the CES
Ed. 32/08 2008 CGFNS. All rights reserved.
I 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 Certificate or a
CGFNS Report or misrepresent a copy as an original, CGFNS may take such 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 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 and potential employers.
You must sign and date this application in order for it to be processed.
Signature of Applicant (Do Not Print)
Sign Entire Name
Date
17 Attestation
Ed. 32/08 2008 CGFNS. All rights reserved.
3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 U.S.A.
Phone: 215.222.8454 Web: www.cgfns.org
Ed. 32/08 2008 CGFNS. All rights reserved.
CGFNS Mission
Provide expert credentials evaluation and professional development
services to promote the health and safety of the public.