Credentials Evaluation Service Applicant Handbook

Credentials
Evaluation Service
Applicant Handbook
The CGFNS Credentials Evaluation Service (CES)is a A requirement in certain states
requirement in certain states and territories in the United
States, for state licensure of registered and practical nurses and territories in the United States
who were educated outside the United States. It is also used for state licensure of registered
by U.S. schools and prospective employers to assess the
education of nursing professionals who wish to continue and practical nurses who were
their education or to be employed in the United States. educated outside the United
The Credentials Evaluation Service results in a written States.
report detailing the applicant’s education and professional
registration/licensing/certification credentials. Some
organizations require the Healthcare Profession & Science
It is also used by U.S. schools
report and others require the Full Education Course-by- and prospective employers
Course report. Applicants will need to designate the
report that is required by the receiving organization.
to assess the education of
nursing professionals.
CGFNS has issued more than 40,000 Credentials
Evaluation Service reports to nursing
professionals educated outside the United
States during the past 17 years.
Revised April 2010 Copyright © 2010 CGFNS International. All rights reserved.
CGFNS contact information
CGFNS Customer Service* +1 (215) 349 8767
Appointments* +1 (215) 222 8454
Mailing address Suite 400, 3600 Market Street, Philadelphia, PA 19104-2651
CGFNS Web site http://www.cgfns.org
CGFNS Connect https://www.cgfns.org/cerpassweb/intro.jsp
Apply/Check Status https://www.cgfns.org/cerpassweb/intro.jsp
Email https://www.cgfns.org/cerpassweb/processContactUs.do
*check sidebar on https://www.cgfns.org/cerpassweb/processContactUs.do for times
Table of contents
Introduction to CGFNS Credentials Evaluation Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Choose from two types of reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Document and File Retention Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What this handbook contains.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ways to apply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
How to complete the application .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Item 1. Credentials Evaluation Service preliminary information.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Item 2. Your name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Item 3. Your other names. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Items 4a and b. Your addresses.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 5. Your marital status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 6. Your birth date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 7. Your gender.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 8. Your citizenship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 9. Your contact details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 10. Your U.S. Social Security Number.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 11. Your education.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Item 12. Your registration/license/certification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Items 13a and 13b. Report recipients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Item 14. Credentials Evaluation Service application fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Item 15. Other fees and payment information.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Item 16. Terms and Conditions of the Credentials Evaluation Service application.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Item 17. Attestation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Additional CES services.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Other CGFNS services.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Additional requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
If your application expires. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Completing the forms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Request for Academic Records/Transcripts form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Request for Validation of Registration/License/Certification form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Authorization to Release Information form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
© 2010 CGFNS International. All rights reserved. The information in this handbook supersedes previously released handbooks
and other documents and Web pages.
Before you send your application to CGFNS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Checklist to make sure your application is complete.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Falsified or altered documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Mailing your application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Guidelines for communicating with CGFNS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CGFNS Connect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Email via Web site. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Letters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
On-site appointments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Telephone calls.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
In the event of a disaster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Credentials Evaluation Service Application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Request for Academic Records/Transcripts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Request for Academic Records/Transcripts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Request for Validation of Registration/License/Certification.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Authorization to Release Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Credit Card Payment Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Introduction to CGFNS Credentials Evaluation Service
CGFNS International’s Credentials Evaluation Service (CES) analyzes the credentials of various types of nursing-related professionals
educated and registered/licensed/certified outside of the United States who wish to work or study in the United States. The CES
report helps qualified nursing professionals meet requirements for licensure or academic admission.
U.S. state boards of nursing and schools require a credentials evaluation to help them appropriately assess educational and
professional credentials earned outside of the country. In addition to boards of nursing and schools, employers, as well as recruiters
and lawyers working on your behalf may request that you complete the CGFNS Credentials Evaluation Service program and provide
them (as a recipient) with one of two reports the service offers. The majority of the U.S. state boards of nursing require CES reports
for foreign-educated applicants seeking licensure for either a registered or a practical nurse in their state.
Choose from two types of reports

A Credentials Evaluation Service report analyzes and compares your education and licensure earned outside of the United States to
that of U.S. standards. In this objective evaluation, CGFNS carefully assesses the documents received from source agencies. The CES
report is advisory in nature and does not make specific placement recommendations. This service does not include an examination.
After all required documents, fees and a completed application are received and analyzed, CGFNS prepares a report and sends it to
the recipient(s) that you designate. You will also have access to view and print the report in your online applicant account through
the CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp.
CGFNS currently offers two types of CES reports. If you are not certain which report you need, please inquire the recipient you
designate to receive your CES report. The two reports are described below:
n Healthcare Profession & Science Report – This report gives general information about the education and professional
registration/license/certification that you earned outside the United States. The Healthcare Profession & Science Report
describes all foreign education and licensure in terms of similar U.S. professions and indicates the U.S. comparability.
When we provide your report to the requested recipient(s), we will attach a copy of your health care academic records/
transcripts.
n Full Education Course-by-Course Report – This report contains the same information as the Healthcare Profession &
Science Report, but is more detailed and contains an analysis of every course from the educational program.
Both CES reports contain an analysis of secondary and post-secondary (tertiary) education, country-specific background information
about schools attended by the applicant, complete dates of attendance, validations of registration/license/certification information
received directly from source authorities. All information is explained in terms of U.S. standards. CGFNS may choose to evaluate only
the documents that it considers relevant to the CES Review.
Document and File Retention Policy

All documents and files are retained in accordance with CGFNS’s Document and File Retention Policy.
What this handbook contains

1. Information regarding the Credentials Evaluation Service program and process.
2. Instructions for completing
n The Credentials Evaluation Service application (see page 2)
n The Request for Academic Records/Transcripts form (see page 6)
n The Request for Validation of Registration/License/Certification form (see page 6)
n and the Authorization to Release Information form (see page 6)
3. Guidelines for communicating with CGFNS (see page 8)
4. The Credentials Evaluation Service application (page 10), a Request for Academic Records/Transcripts (page 16), a Request for
Validation of Registration/License/Certification (page 18), an Authorization to Release Information form (page 19) and a Credit
Card Payment Form (page 20)
This handbook describes how to apply for and receive a CES report. There are many steps (see Table 1 on page 2). Please read this
entire handbook before completing the application or any of the forms. The detailed description of each step will help you to
Revised April 2010
understand the process.
Credentials Evaluation Service Applicant Handbook 1

CGFNS processes all applications at its headquarters in Philadelphia, Pennsylvania, in the United States. If you have any questions or concerns
as you proceed through the CGFNS Credentials Evaluation Service, please contact CGFNS Customer Service by email or by telephone at
+1 (215) 349 8767 during the hours listed on our Contact Us page at https://www.cgfns.org/cerpassweb/processContactUs.do. Refer
to page 8 for guidelines on communicating with CGFNS. For more information on CGFNS and its services, please visit our Web site
at www.cgfns.org.
Table 1: Overview of the steps to receivea CGFNS Credentials Evaluation Service report
Actions You Take Actions CGFNS Takes
Identify the report recipient and the type of report required. Complete an online CGFNS sends you a CGFNS ID number.*
application or download an application and send the original to CGFNS with full payment.
Prepare and send the Request for Academic Records/Transcripts form to any nursing or CGFNS reviews all academic records/transcripts that we
nursing-related post-secondary (tertiary) schools that you attended outside the United receive from your schools. Then we compare them to
States, asking them to send your academic records/transcripts to CGFNS. Send us a information from our global database to find the specific
photocopy of your secondary school certificate/diploma or results of external exams. school and grading system.
Prepare and send the Request for Validation of Registration/License/Certification form CGFNS reviews all registrations/licenses and verifies that
to all licensing authorities outside of the United States who have issued you licenses/ they come from the issuing source.
registrations, asking them to send us the completed form and any attachments.
Check your status online at www.cgfns.org using your username and password. Respond After CGFNS receives and evaluates all the requested
to any correspondence from CGFNS regarding missing items. documents to satisfy the requirements, we issue a report
to the designated recipients. We also provide you access
to an applicant copy of the report in your online account.
Please note: All steps must be completed successfully, or application will be deemed incomplete.
*Note: If you have ever applied for a CGFNS service in the past, the CGFNS ID number you were issued at that time will remain your permanent CGFNS ID number.
Ways to apply
The most convenient method is to apply online at CGFNS Connect: https://www.cgfns.org/cerpassweb/intro.jsp. Completing the
application online will reduce the processing time.
If you apply online, you must still mail certain documents, e.g., copies of secondary school education documents.
The other method is to complete and mail the application on page 10 of this handbook.
How to complete the application

Item 1. Credentials Evaluation Service preliminary information
See page 10.
a. Please check/tick the box that describes how you learned about CES.
b. Please check/tick the box that describes why you selected CGFNS to prepare your evaluation.
c. Please print or type the title of your profession.
d. Please check/tick yes or no whether you have previously taken and passed the NCLEX-RN® or NCLEX-PN®.
e. If you have previously applied to CGFNS for another service, please print or type your CGFNS ID number and your order
number, if known, in the boxes provided.
f. Please print or type the name of the country where you worked, your profession and the number of years you worked in
this profession.
Item 2. Your name

Please print or type your name as you would like it to appear on your CES report (see page 10).
If you need to change your name during the application process, CGFNS will only make the change in your file when we receive your
signed, written request with legal evidence of name change. Requests to change your mailing address must be in writing or you may
make the change online through CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp. In your written request for any of
these changes, remember to include your full name, CGFNS ID number and birth date.
Revised April 2010
Please note: Email requests for name change will not be accepted at any time.
2 Credentials Evaluation Service Applicant Handbook

Item 3. Your other names
Please print or type all names you have used in the past. This is necessary because CGFNS must be able to recognize all your
documents, with any variation or form of your current or previous names. Any name used that is different from your current name
should be printed in this space. This would include your birth name as well as different spellings, informal variations, abbreviations
and different orders of your name. Include copies of legal documentation or notarized affidavit(s) verifying your name change with
your application. For instance, if married, a copy of your marriage certificate or notarized affidavit needs to be attached (see page 10).
Items 4a and b. Your addresses

a Please print or type the address where you want to receive mail from CGFNS. If you authorize someone else to receive your
mailings from CGFNS, all correspondence will go to that person’s address.
b. Please print or type the address where you reside.
If your address changes at any time during the application process, you must notify CGFNS in writing or make changes to your contact
information in CGFNS Connect, the online application system, at https://www.cgfns.org/cerpassweb/intro.jsp. (see pages 10–11).
Item 5. Your marital status

Please check/tick your marital status (see page 11).
Item 6. Your birth date

Please print or type your birth date, using letters for the month and numbers for the day and year (see page 11).
Item 7. Your gender

Please check/tick the box that indicates whether you are male or female (see page 11).
Item 8. Your citizenship

Please print or type your birth country, birth state/province, your native language and the country where you hold current citizenship
(see page 11).
Item 9. Your contact details

Please print or type the contact information where you can be reached. Please answer the questions regarding preferred and optional
ways CGFNS may contact you (see page 11).
Item 10. Your U.S. Social Security Number

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

On page 11–12, please list all the primary, secondary and post-secondary (tertiary) schools that you attended, and also the countries
where the schools were located and your attendance dates. Include all schools, whether or not you completed the program. Include
the following information:
n name of the school
n city, state/province, and country where it is located
n profession title you obtained
n month and year you entered the school
n month and year you completed your coursework or graduated, and
n name of diploma or certificate in its original language using English characters
Please check/tick whether or not your education resulted in a degree. Explain any gaps in your educational history on a separate sheet.
Please send a copy of the Request for Academic Records/Transcripts form to each health care school listed, requesting they complete
their section and send directly to CGFNS. CGFNS can only accept the academic records/transcripts directly from the school or
authorized issuing agency, not from you or a third party.
Revised April 2010
Note: Please check/tick whether or not any of your health care schools have closed or merged with another school. If yes, please
provide the name of school or authority that is in possession of your academic records/transcripts. Please contact the Ministry of
Education or appropriate government department and request they send CGFNS a letter advising of that closing.

Secondary school diploma/certificate
Please submit with your application a legible copy of your secondary school diploma/certificate, results of an secondary school
external exam or secondary school equivalent certificate.
n Diploma not in 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 the Certificate of Accuracy, must be typed or written at the end of the translation and must be
signed by the translator. It does not need to be notarized. Secondary school certificates or diplomas do not need to be
translated by an “official” translator.
Example of Certificate of Accuracy
This is to certify that this is a true and correct English translation of the attached photocopy of the original [insert name
of document] of [insert applicant name].
n Unable to obtain a copy of your diploma or certificate

If you cannot obtain a copy of your diploma, you may request that your secondary school mail a letter directly to CGFNS,
confirming your attendance and graduation dates. If you cannot obtain a copy of the certificate that was awarded to you
based on the results of an external exam (e.g., GCE, GCSE, Irish Leaving Certificate, WAEC), please ask the examining board
to mail a letter directly to CGFNS certifying the grade(s) earned on the examination(s).
Letters submitted by a secondary school/examining board must be written on official stationery, be signed by an
appropriate school official or examining board official and be affixed with the school’s/examining board’s stamp or seal.
n Form V
If you were educated in a country where Form V completion is considered finishing secondary school, please submit with
your application one of the following documents as verification:
– Form V completion statement issued by the appropriate school official or
– official secondary school academic records/transcripts showing Form V completion or
– external examination results.
Item 12. Your registration/license/certification

See page 13.
A. Please check/tick the appropriate box that indicates whether or not your diploma gives you the right to practice, because
your country does not issue a license. If yes, provide diploma number.
B. Please check/tick the appropriate box which indicates whether or not you are currently registered/licensed/certified, and if
you are not, please provide an explanation in the space provided.
C. Please print or type your legal professional title(s), registration number and country(ies) where you are currently registered/
licensed.
D. Please print or type the state(s)/province(s)/country(ies) where you have ever held registration/licenses/certification.
E. Please check/tick the appropriate box which indicates whether your registration/license/certification has ever been
revoked, suspended or restricted for all registration/licenses/certification that you hold now and/or have held in the past.
If yes, please provide an explanation in the space provided.
Items 13a and 13b. Report recipients

List the names and addresses of one or two recipients for your CES report. This could include a state board of nursing, a school or
a potential employer. For each recipient, request the report type and purpose. At least one recipient is required to process your
application. You are automatically provided with an online applicant copy of the report, it is not necessary to list yourself (see pages
13 and 14).
Please note: The CES report is used by U.S. organizations and schools. If you are indicating an international recipient please provide
a written explanation.
Item 14. Credentials Evaluation Service application fees

On page 14, please check/tick only one box of the two types of CES report, either the Healthcare Profession & Science Report or the Full
Education Course-by-Course Report. Please check/tick whether you want the CES English language report or any additional service for
the Credential Evaluation Service. Add the amounts of the services you checked/ticked to obtain a total of the fees due.
Revised April 2010
Item 15. Other fees and payment information

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

Item 16. Terms and Conditions of the Credentials Evaluation Service application
On page 15 is a summary of the Terms and Conditions of the Credentials Evaluation Service.
Item 17. Attestation

The attestation on page 15 creates a contract between you (the applicant) and CGFNS. It explains the terms under which CGFNS will
process your application. After reading it carefully, sign and date the application. By signing the form, you certify that no portion of
the documents submitted to CGFNS on your behalf is falsified, altered or tampered with by any person. CGFNS and others will rely
on this application and on the documents and information submitted. If any portion of the application or documents submitted
is falsified, altered or tampered with, or if you alter a CES report or misrepresent a copy as an original, CGFNS may take any action
against you that it deems appropriate, including barring you from future participation in any CGFNS programs. The consequences
could adversely affect your professional license, immigration status, employment and other matters.
Signature
Sign the application form with the same name you indicated in Item 2 of this application. You will be required to use the same
signature each time you correspond with CGFNS or if CGFNS asks for your signature. The resulting CES report will be issued using
the name provided on your application. The application form does not need to be notarized.
Additional CES services

BEFORE REPORT IS ISSUED
n Additional CES report recipients – This is for those who want to send the Credentials Evaluation Service report to more
recipients than the two included in the application (such as other state boards of nursing or schools)
n Evaluation of an additional academic credential
n Evaluation of an additional registration/license/certification
AFTER REPORT IS ISSUED

n Duplicate Credentials Evaluation Service report for applicant – This is for applicants who want an unofficial copy of their
report mailed to them
n Re-evaluation of a Full Education Course-by-Course Report – After one report has been issued, another Full Education Course-
by-Course Report can be completed and issued to one or two designated recipients
n Re-evaluation of a Healthcare Profession & Science Report – After one report has been issued, another Healthcare Profession
& Science Report can be completed and issued to one or two designated recipients
Fees for additional CES services can be found at http://www.cgfns.org/sections/apply/fees.shtml
Other CGFNS services

n Forwarding academic records/transcripts – This is a request for CGFNS to only send copies of your official academic
records/transcripts to a licensing board or educational institution
n Forwarding academic records/transcripts and registration/licenses/certification – This is a request for CGFNS to only send
copies of both your official academic records/transcripts and your official professional registration/license/certification
validations to a licensing board or educational institution
n Document translation – This is to request that CGFNS have your required documents translated into English
Fees for other CGFNS services can be found at http://www.cgfns.org/sections/apply/fees.shtml
Additional requirements
n English language proficiency report – This is for state boards of nursing that require an English proficiency report included
with Credentials Evaluation Service report.
n New Jersey, Colorado, Virginia and Wisconsin (practical nurse only) require proof that the applicant has achieved a passing
score on the English Proficiency examination required by the Department of Homeland Security for certification of health
care workers in Section 343 of the Illegal Immigration Reform Immigrant Responsibility Act of 1996. The Michigan Board of
Nursing also requires proof of English language proficiency for applicants who graduated from a nursing school taught in
Revised April 2010
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.

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

The Request for Academic Records/Transcripts form
To supply CGFNS with the necessary information about your education, you will need to send one copy of the Request for Academic
Records/Transcripts form (on page 16) to each health care post-secondary (tertiary) school that you attended outside the United States
and request they send us your academic records/transcripts. Complete the requested information in the applicant’s section before
sending it to each school that you attended.
Please note: Enclose any payment that your school(s) may require (including translation costs).
IMPORTANT: We must receive all of your nursing-related academic records/transcripts directly from your school(s). We cannot accept
records supplied by you or anyone else other than the school. If CGFNS receive documents that are not in English without an English
translation attached, we can have them translated for the fee listed on the fees page at http://www.cgfns.org/sections/apply/fees.
shtml, at your request. Further information may be required after your academic record/transcripts are reviewed.
The Request for Validation of Registration/License/Certification form

You must request validations for your current and initial registrations/licenses obtained outside the United States. To do this, use the
Request for Validation of Registration/License/Certification included on page 18 in this handbook. Complete the requested information
in the applicant’s section at the top of the form before sending it to each licensing authority that issued your registration/license/
certification. The section at the bottom titled “FOR LICENSING AUTHORITY TO COMPLETE” is to be completed by them. If you have
a diploma that authorized you to practice in your country, send this form to the institution that issued your diploma (for example,
your school or the Ministry of Health) and request that an official copy of the diploma in the original language be sent to CGFNS. If
CGFNS receive documents that are not in English without an English translation attached, we can have them translated for the fee
listed on the fees page at http://www.cgfns.org/sections/apply/fees.shtml, at your request.
Please note: If validation of your non-U.S. registration/license/certification was previously mailed to CGFNS for another CGFNS
program with an issue date of three or more years ago, it needs to be validated again. Validation of U.S. state licensure is not required
for CES reports. Further information may be required after your registration/license/certification forms or diplomas are reviewed.
The Authorization to Release Information form

This form is available on the Web site at http://www.cgfns.org/sections/apply/forms.shtml and page 19 of this handbook.
Because we protect your privacy, your application will only be discussed with you. If you choose to let CGFNS disclose file information
or provide file status information to another person, you need to submit an Authorization to Release Information form, to designate
an authorized agent. Or, if you choose to have all mail from CGFNS sent to someone else, you can do this by either completing the
Authorization to Release Information form or providing the other person’s mailing address on your application form.
The Authorization to Release Information is valid for two years. You can revoke the authorization at any time. We must receive a
revocation in writing by postal mail or courier service.
The completed Authorization to Release Information form may be submitted to CGFNS with your application or mailed separately by
postal mail or delivered by courier.
Please note: CGFNS only keeps one mailing address per applicant. Therefore, if you choose to have your correspondence from
CGFNS sent to an alternative address, all correspondence will be sent to that person. CGFNS cannot be held responsible for any
Revised April 2010
correspondence withheld by a third party you designated as an authorized agent.

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

Before you send your application to CGFNS
Checklist to make sure your application is complete
Check each item below to ensure that you avoid common application ISSUES
Before mailing your application, check to see that you have:

verified that you have completed each item on the application (pages 10–15).
included documentation of your secondary school education or external exam certificate, with literal English
translations, including a Certificate of Accuracy (see page 4).
completed the enclosed Request for Academic Records/Transcripts form and sent them to the appropriate schools (see
pages 6 and 16).
completed the enclosed Request for Validation of Registration/License/Certification form and sent them to the appropriate
licensing authorities (see pages 6 and 18).
checked that every document is either in English or has a literal English translation attached that includes the Certificate
of Accuracy, signed by the translator (see page 4).
signed the Authorization to Release Information form, if you would like CGFNS to communicate with someone other than
yourself (see pages 6 and 19).
included full payment through a bank check, an international money order (drawn on a United States bank in United
States dollars) made payable to CGFNS or credit card payment (Visa, MasterCard or Discover), with the completed Credit
Card Payment form. DO NOT SEND CASH (see pages 4 , 14 and 20).
completed and signed this Credentials Evaluation Service application form.
THESE DOCUMENTS HAVE TO BE SUBMITTED DIRECTLY FROM OTHER AUTHORITIES TO CGFNS:

If they are required by your recipient, English language proficiency scores from ETS or IELTS (see page 5).
Completed Request for Registration/License/Certification forms, that you sent to them, and corresponding documents
directly sent from all licensing authorities (see pages 6 and 18).
Completed Request for Academic Records/Transcripts forms and corresponding records, that you sent to them, from each
post-secondary health care school you attended (see pages 6 and 16).
Certified translation of any documents not in English.
Please note: CGFNS does not return any of the documents that are part of your complete application. Please send only legible
photocopies, not originals, of the documents CGFNS requests directly from you. Applications remain open for 12 months.
Falsified or altered documents

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

After completing your application form, send it to CGFNS International along with a photocopy of your secondary school diploma
and all required fees. Send your application documents to the following address:
CGFNS International
3600 Market Street, Suite 400
Philadelphia, PA 19104-2651 USA
Revised April 2010

Guidelines for communicating with CGFNS
If you have questions about your application or required documents, we recommend that you first go online to CGFNS Connect
Apply/Check Status at https://www.cgfns.org/cerpassweb/intro.jsp on the CGFNS Web site to check the status of your account. You
may also contact CGFNS via letter, telephone or through the contact form on our Web site at https://www.cgfns.org/cerpassweb/
processContactUs.do. We offer the following guidelines to make this communication easier (see Table 2 on page 9 for additional
information).
CGFNS Connect
You can apply for CGFNS’s services online through CGFNS Connect at https://www.cgfns.org/cerpassweb/intro.jsp. A benefit of
CGFNS Connect is that you can access your application status through your browser. By creating an account (through specifying a
user name and password) with CGFNS, you can check your application order status, verify receipt of documents and scores, make
changes to your contact information, confirm mailing dates and access many other services.
Email via Web site

You may email CGFNS Customer Service with questions regarding your application through the Contact Us form on our Web site
at https://www.cgfns.org/cerpassweb/processContactUs.do.
Letters
When you mail a letter, it must be written and signed only by you for confidentiality purposes. When you write to us, always include
your CGFNS ID number, full name and birth date. CGFNS recommends that you send all correspondence by air mail, and that you
consider using express couriers when time is limited.
On-site appointments
You or your authorized agent may call +1 (215) 222 8454 to schedule a 30-minute appointment in our CGFNS office in Philadelphia,
Pennsylvania, to discuss your file. See the Contact Us form on our Web site at https://www.cgfns.org/cerpassweb/processContactUs.
do for appointment days and times.
Telephone calls
CGFNS Customer Service provides applicant status information by telephone to applicants only. CGFNS will not release information
by phone to anyone else unless a completed and signed Authorization to Release Information form has been received from you. If
you wish to telephone CGFNS, call CGFNS Customer Service at +1 (215) 349 8767. To save time, have your CGFNS ID number ready.
If the Customer Service Representative is unable to adequately verify your identity, information will not be released by telephone.
For the times CGFNS Customer Service is open for telephone calls, go to the Contact Us form at https://www.cgfns.org/cerpassweb/
processContactUs. CGFNS Customer Service is not available weekends or U.S. holidays. CGFNS does not accept reverse charge
telephone calls.
In the event of a disaster

CGFNS makes every effort to ensure that our communication with applicants is straightforward and timely. However, some events
are out of our control. Events such as natural disasters, political unrest and postal strikes may occasionally occur. CGFNS cannot be
responsible for delays caused by such conditions, but we will make every reasonable effort to notify you when this happens.
Please note: It is your responsibility to notify CGFNS of any change in your contact information, especially in the event of a disaster
in your country.
Revised April 2010

Table 2: Communication guidelines
Reason for Who Can Initiate Communications Channel YOU NEED
Communication Request?
You want to confirm whether Only you or your Email through the Contact Us form on our Web site at Include your full name,
CGFNS received your authorized agent https://www.cgfns.org/contact/, write, telephone or visit CGFNS ID number and
application documents CGFNS Connect at https://www.cgfns.org/cerpassweb/intro. birth date
jsp
You have a question about a Only you or your Email through the Contact Us form on our Web site at Include your full name,
letter that you received from authorized agent https://www.cgfns.org/contact/, write or telephone CGFNS ID number and
CGFNS birth date
You need to notify CGFNS of Only you or your Email through the Contact Us form on our Web site at Include your full name,
your address change authorized agent https://www.cgfns.org/contact/, write or make changes via CGFNS ID number and
the online application system (CGFNS Connect) at https:// birth date
www.cgfns.org/cerpassweb/intro.jsp
You need to notify CGFNS of a Only you Write to CGFNS including legal documentation of name Include your full name,
legal name change change CGFNS ID number and
birth date
Revised April 2010
©2010 CGFNS. All rights reserved.

Credentials Evaluation Service
Application
CGFNS International • 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 USA • +1 (215) 222 8454 • www.cgfns.org
Provide all information requested below. Note that inaccuracies will delay the processing of your application.
Enter responses legibly. Submit original copy. Retain a copy for your files. See instructions on pages 2 – 5.
1 Credentials Evaluation Service preliminary information

Please assist us by answering these questions. Your cooperation will aid us in serving you better in the future.
a. How did you learn about CGFNS’s Credentials Evaluation Service?

n U.S. College/University n State licensure board n Recruiter n U.S. employer n Immigration attorney
n CGFNS mailed you information n Other (please explain)
b. Why did you select CGFNS Credentials Evaluation Service over another organization’s service?
n Instructed by your report recipients n You requested an application n Price n CGFNS’s reputation
n Other (please explain)
c. Title of your profession
d. Have you taken and passed the NCLEX-RN®? n Yes n No Have you taken and passed the NCLEX-PN® ? n Yes n No
e. Your CGFNS ID number, if you have one Order number, if known
f. I worked in as a for years

City/Country Profession specialty
2 Your name
Print or type your name as you would like it to appear on all correspondence and the report. Please print or type only one letter in each box.
First (given) and middle names (leave a space between names)
Last (family / surname) name(s) (leave a space between names)
3 Your other names (if applicable)

Please print or type all other names appearing in your documents. Include legal documents verifying name change (for example: a marriage certificate).
Name before marriage
Other name(s) (leave a space between names)
4a Your mailing address (Note: You are responsible for notifying CGFNS if your address changes)
Print or type the address where CGFNS will mail all your correspondence.
Street
Street
City
Revised April 2010
State / Province Post / Zip code
Country

4b Your residential address (Please note: You are responsible for notifying CGFNS if your address changes)
Print or type the address in which you reside.
Street
Street
City
Country
5 Your marital status 6 Your birth date (spell the month, enter numbers for the day and year of your birth)
n Married n Divorced Month Day Year
n Widowed n Single (never married)
7 Your 8 Your citizenship

gender
Birth country
n Female
n Male Birth state/province
Native language
Country where you hold current citizenship
9 Your contact details
Telephone (include country code and area code) Mobile phone (include country code and area code) Fax (include country code and area code)
Email (required)
May CGFNS contact you to discuss your transition to practicing in the United States? n Yes n No
May CGFNS send you text messages? n Yes n No
What is your preferred method of communication from CGFNS? n Postal mail n Email
10 Your U.S. Social Security Number (if you have one)
11 Your education (Please note: Inaccuracies in this section will result in delay of the processing of your application)
Please list every school in the order you attended them, whether or not you completed each course. Explain any gaps in time in your
educational history on a separate sheet. If the school has closed or merged with another school, provide the name and address where your
records are located, if known. Also use a separate sheet if you attended more schools than there is room for in each table.
Primary education
Name of diploma
or certificate in its
Month/ Month/ original language
Year Year (please use English
Name of primary schools attended Address, city and country entered completed alphabet)
1
/ /
Revised April 2010
2
/ /
Secondary education (or equivalent)
Enclose a photocopy of your diploma, certificate or external exam certificate from your secondary school (or secondary school equivalent),
including word-for-word English translations of each of these documents. External exam results and completion date verification must be
submitted directly to CGFNS by the examining agency or school.
Name of diploma
Month/ Month/ original language
Name of secondary schools Year Year (please use English
(or equivalent) attended Address, city and country entered completed alphabet)
1
/ /
2
/ /
Post-secondary (tertiary) non-health care education
Complete all information requested for your non-health care post-secondary (tertiary) schools.
Name of diploma
Name of non-health care Month/ Month/Year original language Degree
post-secondary (tertiary) schools Year completed/ (please use English obtained
attended Address, city and country entered graduated alphabet) ()
1
/ /
2
/ /
3
/ /
Post-secondary (tertiary) health care education
Complete all information requested for your health care post-secondary (tertiary) schools. Complete the top section of the Request for Academic
Records/Transcripts form and send it to each of your schools to complete. The school is requested to send to CGFNS directly your academic
records/transcripts and the completed form.
Name of diploma
Name of health care Month/ or certificate in its
post-secondary (tertiary) Month/ Year original language Degree
schools attended and Street, city, state/province, Professional Year completed/ (please use English obtained
contact information country (will be verified) title obtained entered graduated alphabet) ()
1
CONTACT / /
2
CONTACT / /
3
CONTACT / /
Have any of your health care schools closed or merged with another school? n Yes n No
Revised April 2010
If yes, write the name of school or other authority in your country of education that is in possession of your academic records/transcripts.

12 Your registration/license/certification
Please provide the following information and forward the Request for Validation of Registration/License/Certification form to all the licensing
authorities where you have ever held a registration/license/certification outside of the United States. If your diploma authorizes you to practice in
your country, send form to the institution that issued your diploma. Validation of U.S. state licensure is not required for CES reports.
A. If your country does not issue a license, does your diploma give you the right to practice? n Yes: number n No
B. If you are not currently registered/licensed/certified, please indicate n Not currently n Never
and explain:
C. List your legal professional title(s), registration numbers and all countries where you are currently registered/licensed/certified.
D. List any other state(s)/province(s)/country(ies) where you have ever held registration/license/certification.
E. Have any of your registrations/licenses ever been revoked, suspended or restricted for any reason?
n Yes n No If yes, please explain:
13a First of two report recipients At least one report recipient is required to process your application. (Note: You are automatically provided with an
online applicant copy of the report, it is not necessary to list yourself as a recipient)
Indicate the name and address of the first recipient of your report.
Organization name
Contact person name and title
Street
Street
City
Country
Report type
Refer to page 1 of this handbook for an explanation of both CES reports.
n Healthcare Profession & Science Report n Full Education Course-By-Course Report
Report purpose
Revised April 2010
n RN licensure exam n PN licensure exam n RN licensure by endorsement n LPN licensure by endorsement

n Academic admission n Employment n Immigration
n Certification n Other

13b Second of two report recipients (Note: You are automatically provided with a copy of the report, it is not necessary to list yourself as a recipient)
Indicate the name and address of the second recipient of your report.
Organization name
Contact person name and title
Street
Street
City
Country
Report type
Refer to page 1 of this handbook for an explanation of both CES reports.
n Healthcare Profession & Science Report n Full Education Course-By-Course Report
Report purpose
n RN licensure exam n PN licensure exam n RN licensure by endorsement n LPN licensure by endorsement
n Academic admission n Employment n Immigration
n Certification n Other
14 Credentials Evaluation Service application fees

Please check/tick only one box of the two types of CES reports. If you are requesting that two different types of reports be issued to your
recipients, you should pay for the CES Full Education Course-By-Course Report.
Refer to the fee schedule online at http://www.cgfns.org/sections/apply/fees.shtml.
n CES Healthcare Profession & Science Report $___________

n CES Full Education Course-By-Course Report $___________
n CGFNS English language report $___________
n Additional CES Services $___________
Total fees due $___________
15 Other fees and payment information

Fees for CGFNS services are located online at http://www.cgfns.org/sections/apply/fees.shtml and fees are subject to change. Full payment
for all services must be made before your application and documents can be reviewed. If you use a credit card, you may pay online at https://
www.cgfns.org/cerpassweb/intro.jsp or use the Credit Card Payment Form on page 20 in this handbook. We accept Visa, Mastercard and
Discover. Alternatively, you may submit an international money order or certified bank check paid in U.S. dollars, drawn on a U.S. bank, and
made payable to CGFNS. Personal checks are not accepted. Please do not send cash.
Please note: Any money submitted to CGFNS will first be applied to any unpaid balance on previous orders/services before new orders are
processed. The fee covers the expense of processing your application, scanning documents, reviewing your credentials, and preparing and
issuing the CES report.
Revised April 2010

16 Terms and Conditions of the Credentials Evaluation Service
The following clarifies the obligations of the Credentials Evaluation Service provider (CGFNS) and applicant (you), as well as the manner in
which this service is delivered.
n CGFNS may choose to evaluate only the documents it considers relevant to the CES review.
n All documents submitted, including academic records/transcripts, become the property of CGFNS and will not be returned to you. Do not
send original diplomas, degrees, certificates, registrations or licenses.
n If your application includes any falsified, altered or tampered with documents or information, CGFNS will send the report to the designated
recipients, and notify them of the falsification.
n No evaluation is conducted until CGFNS receives a complete application and full payment. Please include payment with your application.
n State boards of nursing and applicants have access to CES reports online. All CES reports to recipients other than state boards of nursing
(e.g., schools, recruiters, employers and immigration attorneys) are sent via first class mail (within the United States) or air mail (outside
of the United States).
n Fees are subject to change and are found at http://www.cgfns.org/sections/apply/fees.shtml
n Any payment sent to CGFNS will be applied first to any unpaid balance from previous orders for products or services before it is applied
as payment to this application.
n You are given 12 months to meet the requirements of the initial application order, after which it expires. If an initial application that has been
paid in full expires, you have up to 12 months to apply for a reprocess (another 12 months on that application) and fully pay the reprocess
fee listed in the fees table at http://www.cgfns.org/sections/apply/fees.shtml. If you have NOT paid in full, or if fees paid were applied to
previous services, and the initial application order expires, you do not qualify for the reprocess, but must submit a new application and
pay the full fee to have 12 months to process the application and complete all the requirements. The subsequent 12 months begins when
we receive the application. Only one reprocess application is accepted after an initial CES application expires.
n No refund is given after an application is submitted.
17 Attestation
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 report or misrepresent a copy as an original, CGFNS may take disciplinary action
against me as it deems appropriate and the consequences could adversely affect my professional license, immigration status, employment
and other matters from which I release CGFNS from all liability.
I authorize CGFNS to disclose the information and documents in this application, the status of any CGFNS certificates, reports or evaluations
prepared by CGFNS, any other information obtained by CGFNS, and the results and reasons for any adverse action taken against me by CGFNS
to any person or organization I designate in writing or to any other recipient who CGFNS may determine has a legitimate interest in receiving
the same, such as government agencies and potential employers.
You must sign and date this application in order for it to be processed.
Your signature
Sign entire name
Print your name Date

Month / Day / Year
Mail the completed application and payment to CGFNS International, 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA
©Copyright 2010 CGFNS. All rights reserved.

Revised April 2010

Request for Academic Records/Transcripts
FOR APPLICANT TO COMPLETE BEFORE SENDING TO SCHOOL
My current name
First (given) name Middle name Last (family / surname) name
Name of school I attended
I attended between the dates of and My birth date

Month Year Month Year Month Day Year
My name when I attended this school
First (given) name Middle name Last (family / surname) name
My other names
My CGFNS ID number (if known) My order number (if known)
Applicant signature
My current mailing address
Address
Address City
State / Province Post / Zip code Country
Telephone number (include country code and area code) Fax number (include country code and area code) Email address
For SCHOOL to complete
Dear Registrar:
Please complete this section of the form and send it to CGFNS along with the above applicant’s academic record(s)/transcripts listing the courses
taken, hours of study and grades earned, accompanied by a certified English translation.
1. Applicant name
2. In what language was the applicant instructed? Applicant’s birth date / /

Month Day Year
3. What was the textbook language for the applicant’s program/course of study?
4. Program type (e.g., diploma, baccalaureate) Course of study
5. Attendance dates to Did applicant complete program ? n Yes n No

Month Year Month Year
6. School name
SEAL
7. School address OR

STAMP
Address City

Revised April 2010
Continued on following page

Request for Academic Records/Transcripts
For SCHOOL to complete, page 2
8. School telephone School fax
9. School email address School web address
10. Is this school accredited or government approved? n Yes n No
By whom? Date accredited or approved / /

Month Day Year
Is this educational program accredited or government approved? n Yes n No
By whom? Date accredited or approved / /

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

SEAL
Do not print, sign entire name. School seal or stamp must cover signature.
Date
Month
/
Day
/
Year
OR
STAMP
Print name Title
In addition to attaching a copy of the academic record(s)/transcripts(s), please provide specific hours of theoretical instruction and hours of clinical
practice for the subject areas listed below. Please do not combine subject areas. If they are combined in your curriculum, please estimate the
hours of theoretical instruction and hours of clinical practice in each subject area. Both the completed form and educational academic record(s)/
transcripts(s) must be sent directly to CGFNS. All documents must be in English.
Theoretical Clinical Theoretical Clinical

instruction practice instruction practice
Subject hours* hours Subject hours* hours
Care of the adult — Medical nursing Humanities
Care of the adult — Surgical nursing Art
Maternal/Infant nursing English
Nursing care of children Foreign language
Psychiatric/Mental health nursing History
Community health/Public nursing Music
Gerontology nursing Philosophy
Gynecology Religion
Neurology Speech
Anatomy
Physiology Social and Behavioral Sciences
Microbiology Anthropology
Pharmacology Archaeology
Nutrition Economics
Mental health concepts Human geography
Political science
Psychology
Sociology
Revised April 2010
* Includes classroom education, laboratory and planned clinical conferences (ward teaching) hours. CGFNS must have the breakdown of theoretical instruction
hours and applicable clinical practice hours for each of the subjects, not combined.
Please send this document and academic record(s)/transcripts(s), in English, in an CGFNS International
envelope with your seal or stamp over the flap after sealing. Send via airmail to ➨ 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA

Request for Validation of Registration/License/Certification (also validation of diploma if it authorizes
you to practice in your country)
FOR APPLICANT To COMPLETE BEFORE SENDING TO LICENSING AUTHORITY

My current name
First (given) name Middle name Last (family/surname) name
My birth date My CGFNS ID number My order number

Month Day Year (if known) (if known)
Registration/License/Certification number Professional title

The registration/license/certification was issued under the name
First (given) name Middle name Last (family/surname) name
Applicant signature
My current address
Address
Address City
For licensing authority TO COMPLETE

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

Applicant name
number to practice as a on / /
Specify legal title Month Day Year
The expiration date of this registration / license is / / Applicant birth date / /

Month Day Year Month Day Year
2. Ability to practice granted by: n National / Provincial / State examination n LIcensure exam date / /
Month Day Year
n Registration n Diploma (NOTE: Please attach a copy of the original language diploma/certificate with literal English translation)
n Review of another license (endorsement) n Other
3. Status: n Active / Current n Expired n Inactive n Restricted*
*Please attach an explanation if the applicant’s registration / license / diploma has ever been revoked, suspended, limited or placed on probation.
4. Name and address of professional school
5. Graduation date / /
Month Day Year
6. Is this school accredited or government approved? n Yes n No
By whom? Approval date /

Is this educational program accredited or government approved? n Yes n No By whom?
SEAL
7. Program type: n Diploma n Baccalaureate degree n Associate degree n Other (specify)
OR
8. Licensing or school authority signature Date / /
Do not print, sign entire name. Licensing or school authority seal or stamp must cover signature. Month Day Year

Print name
Licensing or school authority title

STAMP
State / Province and country
Revised April 2010
Telephone number (include country code and area code) Fax number (include country code and area code)
Email address Web address
Please send this document and any attachments, in English, in an envelope with your seal or stamp over the flap after sealing.
Send via airmail to: CGFNS International, 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA
Authorization to Release Information
NOTICE: By signing below you (1) allow CGFNS to disclose confidential, personal, private information about you and your file
at CGFNS to the person designated below; (2) give up the right to receive information from CGFNS directly; and (3) release and
indemnify CGFNS, its members, trustees, officers and employees from any liability for losses, damages or claims of any type arising
out of actions taken by CGFNS in reliance upon this Authorization to Release Information, hereafter known as “Authorization”.
This Authorization will remain valid for two years from the date supplied by you on the “Date” line below (or if no date is supplied,
from the date this Authorization is received by CGFNS).
REVOCATION: This Authorization can be revoked by submitting a new authorization dated and signed after the initial authorization.
In addition, you may revoke this Authorization in writing at any time, which will be effective on or after the 30th day after CGFNS
receives it, by regular mail or courier, at its headquarters office in Philadelphia, Pennsylvania, USA.
AUTHORIZATION: I authorize CGFNS to release to the authorized agent indicated by me below, any and all information about me
and my application/order for services from CGFNS, including, and without limitation, the status of my application/order, the results
of any credentials review, examination or test and any other information in or relating to my file at CGFNS. I understand that all mail
(including certificates, exam scores and reports) will be sent to the authorized agent.
This authorization revokes all previous authorizations submitted by the applicant.
Your CGFNS ID number (if known) 2 Your birth date (spell the month and enter numbers for the day and year)
1
Month Day Year
3 Your signature (the applicant)
Your signature Date / /

Do not print Month Day Year
Print your name
4 Your authorized agent (please print)
Your contact’s name
The organization your contact is representing
Your contact’s address
Day telephone Fax
Evening telephone Email

Revised April 2010
3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA • +1 (215) 222 8454 • www.cgfns.org

INTERNATIONAL COMMISSION on COMMISSION on GRADUATES of
HEALTHCARE PROFESSIONS FOREIGN NURSING SCHOOLS
Credit Card Payment Form A division of CGFNS International A division of CGFNS International
Please type or print legibly. To pay by credit card, please fill in below your name as it appears in your application/order and your
CGFNS ID number (if known). Complete the cardholder information as requested.
1 Applicant name
First (given) and middle names (leave a space between names)
Last (family/surname) name(s) (leave a space between names)
2 CGFNS Applicant ID number (if known) 3 Applicant birth date (spell the month and enter numbers for the day and year)
Month Day Year
4 Cardholder information
Cardholder name (as it appears on card)
First name, middle initial and last name (Leave a space between names)
Credit card type (check one) n Visa n Mastercard n Discover

Cardholder address (for processing credit card payments only)
Street
Street
City State/Province
Post/Zip code Country
Credit card number CVV2 number* (see below for explanation)
Expiration date Month Year Total charges US $

(see fees page online at http://www.cgfns.org/sections/apply/fees.shtml)
*Explanation of credit card CVV2 number

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

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

Revised April 2010
3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA • +1 (215) 222 8454 • www.cgfns.org

CGFNS Mission
To serve the global community through programs and services that verify and promote
the knowledge-based practice competency of health care professionals.
3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 USA

Phone: +1 (215) 222 8454 • Web: www.cgfns.org
Revised April 2010 ©2010 CGFNS. All rights reserved.

Credentials Evaluation Service Applicant Handbook

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Credentials Evaluation Service Applicant Handbook

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Credentials

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Choose from two types of reports

Document and File Retention Policy

What this handbook contains

understand the process.

Credentials Evaluation Service Applicant Handbook 1

How to complete the application

Item 2. Your name

2 Credentials Evaluation Service Applicant Handbook

Items 4a and b. Your addresses

Item 5. Your marital status

Item 6. Your birth date

Item 7. Your gender

Item 8. Your citizenship

Item 9. Your contact details

Item 10. Your U.S. Social Security Number

Item 11. Your education

Credentials Evaluation Service Applicant Handbook 3

n Unable to obtain a copy of your diploma or certificate

Item 12. Your registration/license/certification

Items 13a and 13b. Report recipients

Item 14. Credentials Evaluation Service application fees

Item 15. Other fees and payment information

2 Credentials Evaluation Service Applicant Handbook

4 Credentials Evaluation Service Applicant Handbook

6 Credentials Evaluation Service Applicant Handbook

8 Credentials Evaluation Service Applicant Handbook

10 Credentials Evaluation Service Applicant Handbook

12 Credentials Evaluation Service Applicant Handbook

14 Credentials Evaluation Service Applicant Handbook

16 Credentials Evaluation Service Applicant Handbook