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    Verification of Licensure For Nclex-Rn® Examination: For Graduates Outside of The USA and US Territories

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    BasantaBhattarai
    The document is a verification of licensure form for nurses applying for licensure in Texas who were licensed outside of the US or territories. It contains sections for applicant information and licensing authority verification, and requests details on the applicant's original nursing license and education program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Verification of Licensure For Nclex-Rn® Examination: For Graduates Outside of The USA and US Territories

    Uploaded by

    BasantaBhattarai
    18 views1 page
    The document is a verification of licensure form for nurses applying for licensure in Texas who were licensed outside of the US or territories. It contains sections for applicant information and licensing authority verification, and requests details on the applicant's original nursing license and education program.

    Original Description:

    Rne form

    Original Title

    RNExam2014-VOL-only

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    The document is a verification of licensure form for nurses applying for licensure in Texas who were licensed outside of the US or territories. It contains sections for applicant information and licensing authority verification, and requests details on the applicant's original nursing license and education program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    18 views1 page

    Verification of Licensure For Nclex-Rn® Examination: For Graduates Outside of The USA and US Territories

    Uploaded by

    BasantaBhattarai
    The document is a verification of licensure form for nurses applying for licensure in Texas who were licensed outside of the US or territories. It contains sections for applicant information and licensing authority verification, and requests details on the applicant's original nursing license and education program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    TEXAS BOARD OF NURSING

    333 Guadalupe - Suite 3-460, Austin, Texas 78701


    (512) 305-7400 – Web Site: www.bon.texas.gov
     
    VERIFICATION OF LICENSURE FOR NCLEX-RN® EXAMINATION
    for Graduates outside of the USA and US Territories
     
    SECTION A: APPLICANT PORTION - To be completed by the applicant and forwarded to the ALL appropriate licensure authorities that the applicants has
    been licensed as a professional registered nurse or licensed vocational/practical nurse in the applicable country, state, province, and/or territory.
    Name (First, Middle, Last) All Previous Name(s) used

    Mother's Maiden Name Date of Birth(month/day/year) License Number

    Name as appears on original license (First, Middle, Last) Issuance Date of Original Licensure Name of Country/Province/Territory Issued

    Basic Nursing Education Program- Type of Basic Nursing Program


     
    [ ] Vocational/Practical Program [ ] Other

    LICENSING AUTHORITY PORTION: Only to be completed by the licensing authority


    Licensing Agency: The above named individual has applied for Licensure as a registered nurse in the State of Texas. Please 
    complete the information below in its entirety and return this form to the Board’s address listed above 

    This is to verify
    First Name Middle Name Maiden Name Last Name

    was issued # to practice as a (circle one) RN / LVN nurse on / / .


    month day year

    The license expires on / / or  [       ] issued for life.


    month day year
     
    Licensure status: [ ] Active [ ] Lapsed [ ] Inactive [ ] Encumbered*
    * If license has ever been revoked, suspended, restricted, limited or placed on probation, please attach a letter of explanation.

    Was the applicant originally licensed in your country? [ ] YES [ ] NO


     
    If "NO", what country did the applicant originally receive recognition as a nurse?
     
    Nursing program name:                          
    Location of program:
    City Country
     
    Type of Basic Nursing Education Program: [ ] Diploma [ ] Associate Degree [ ] Baccalaureate Degree [ ] Master’s Degree

    Was this program conducted in English? [ ] YES [ ] NO Date of Graduation: / / (Month/Day/Year)


    *If UNABLE to provide month/day/year of graduation, please attach a letter of explanation.

    Signed
    (Must bear Official Seal here) Must be original signature-Stamped signatures not accepted

    Title

    Country/State/Province/Territory

    Contact phone number/email address

    Date Signed / /
    Month Day Year

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