Date of Birth (yy/mm/dd):
Country of Origin:
Country of Study:
Name of Nursing School:
Graduation Date from Nursing School (YYYY/MM):
Highest Level of Nursing Education:
Years of Experience as a Registered Nurse:
Currently Employed as:
Name of Current Canadian Employer:
Briefly describe most recent nursing position:
For Newcomers to Canada:
Arrival Date in Canada (yyy/mm/dd):
English First Language?
If English is not the first language, was a language proficency test completed?
If yes, name of language proficiency test:
Date of language proficiency test:
Please indicate course(s) you are applying for:
Have you ever been referred for or participanted in a competence assessment and/or education for initial RN registration in Canada?
If yes, when and where?
Name of RN regulatory body you have applied for RN registration in Canada:
Have you been given permission by the RN regulatory body to write the NCLEX-RN?
Note: If you were referred for this education by a RN Regulatory Body (for example, the Nova Scotia College of Nursing) and have signed a Consent for Release of Information, then this completed application can be shared with the RN Regulatory Body.