Evidence of Language Proficiency ─

Education Form
College of Nurses of Ontario Telephone: 416 928-0900
101 Davenport Rd., Toronto, ON M5R 3P1 Toll-free (Canada): 1 800 387-5526
www.cno.org Fax: 416 928-6507

IMPORTANT: The evidence you provide in this form will be used by the College of Nurses of Ontario (CNO)
to determine if the applicant can practice and communicate and understand effectively as a nurse. You
must have/had direct knowledge and contact with the applicant and must provide examples of how they
demonstrate language proficiency in listening, reading, writing, and speaking in English or French relevant
to the last two years. Making a false or misleading representation or statement could result in the
cancellation of the application(s) for registration and/or any certificate of registration that may be issued.
CNO may contact the school as a source to validate the information provided on this form.

Please review the Privacy Policy at www.cno.org/privacy to understand how your personal information
will be used.

How to complete this form:

Step 1: The applicant should complete section 1 and send the form directly to the school. Note: Applicant
should remember to fill out their name and application number in the space provided at the
bottom of each page.
Step 2: The school should complete section 2.
Step 3: The school should prepare a separate document detailing the evidence information CNO
requires as listed in section 3.
Step 4: The school should mail the form and documents in a sealed letterhead envelope to CNO using
the mailing address provided at the top of this form.

1. APPLICANT’S INFORMATION
           
First name Last Name

           
Application number Date of Birth (yyyy-mm-dd)

As part of my application to become a nurse in Ontario, CNO is requesting that your organization provides information
about my education that proves that I am proficient in the English or French language. I hereby give you (my previous
and/or present school) consent to provide any and all information in your possession to CNO regarding my nursing
education. This shall constitute your legal authority to provide the information and any other information which CNO
shall request which may, in any way, be relevant to my application.

     
Applicant’s signature Date (yyyy-mm-dd)

© College of Nurses of Ontario Evidence of Language Proficiency – Education Form (2019-97) 1

 Evidence of Language Proficiency ─
Education Form

2. SCHOOL’S INFORMATION
           
Name of school Telephone number (include country code):

           
Address City

           
Province/State Country

3. EVIDENCE INFORMATION
Provide evidence of education where English or French was the primary language used for communication in
listening, reading, writing and speaking. The education experience must have been completed within the last
two years.

     

Program name

           
Start date (yyyy-mm-dd) End date (yyyy-mm-dd)

The focus of the education was: Nursing Non-Nursing

Confirm if the applicant completed a: (check all that applies)

Clinical practicum placement co-op lab

How many hours did the applicant complete in an actual supervised clinical practicum/placement/co-op?
     
Where was the supervised clinical practice completed?
     
How many hours did the applicant complete in a simulation lab?
     
What is the format of the lab (i.e. SimMan, Standardized Patients)?
     
How many hours did the applicant obtain through Prior Learning Assessment Recognition (PLAR)?
     

Applicant’s Name: __________________ Application Number ___________

© College of Nurses of Ontario Evidence of Language Proficiency – Education Form (2019-97) 2

 Evidence of Language Proficiency ─
Education Form

Please attach the following information to this form and send directly to CNO
1. The applicant’s academic transcript and course descriptions
2. Letter(s) of reference from teacher(s), preceptor(s) or someone who supervised the applicant in practicum,
placement or co-op, and who can provide an evaluation how the applicant uses/used language abilities in
listening, reading, writing and speaking (including examples) in English and French.

I confirm that the evidence attached to this form is accurate and relates to the applicant’s education within
the past two years.

           
School contact name & title School contact name

     
Signature & Date (yyyy/mm/dd) Email address

Applicant’s Name: __________________ Application Number ___________

© College of Nurses of Ontario Evidence of Language Proficiency – Education Form (2019-97) 3