Verification of Course Completion
and Transcript Request
Registered Nurse/Practical Nurse
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
How to complete this form Step 3: The nursing school should return the fully
completed form to the College of Nurses of
Step 1: Applicant should complete section 1.
Ontario (CNO) using the mailing address at the
Step 2: The nursing school should complete section 2. top of this form. See instructions in section 2 of
this form.
Important
CNO will not accept this document if sent by the applicant; it must be sent by the school.
Collection of Personal Information
Please review the Privacy Policy on CNO’s website (www.cno.org/privacy) to understand how your personal
information will be used.
SECTION 1
To be completed by the applicant
Last name Application number
First name Previous Name(s)
Applicant’s mailing address School of Nursing
Apt/unit# Name of Program completed
❏ Registered Nurse
City
❏ Registered Practical Nurse
Province/State Postal/Zip Code Country ❏ Other ___________________________________________
Date of birth (MM/DD/YYYY) Graduation date (MM/DD/YYYY)
Gender: ❏ Female ❏ Male Student number (if applicable) ____________________________________
I authorize _______________________________________________ to provide the information requested in Section 2
Name of the School of Nursing
and any and all information in its possession to the College of Nurses of Ontario regarding my education. This shall
constitute your legal authority to provide any and all information which the College of Nurses of Ontario shall
request which may, in any way, be relevant to my application.
Applicant’s signature:____________________________________ Date: ______________________________
MM/DD/YYYY
FEB 2021
2021-11
Verification of Course Completion
and Transcript Request
Section 2 — Nursing School: Please complete Section 2 of this form and include an official transcript that
includes a list of the grades achieved, a breakdown of hours of theory and clinical practice for each subject and a
copy of the course descriptions/outlines and outcomes of the program the applicant completed. Send directly to
the College of Nurses of Ontario in an envelope bearing the letterhead, seal or stamp of the Nursing School.
SECTION 2
To be completed by the Nursing school Attention applicant: Do not complete Section 2
School of Nursing Type of school (e.g. College, Hospital, University, Vocational)
Address Telephone number (include country code))
City/Town Email address
Province/State Postal/Zip Code Country Fax number (include country code)
1. Name of the program: _________________________ 8. The program was officially recognized or
approved by:
______________________________________________
2. Total number of years of education required for Name of the Nursing Regulatory Body/Board, Licensing/Recognition
admission to the program: _________________ years Governmental Authority or Accrediting Organization)
3. Date of admission: 9. What is the primary language of your educational
institution? ____________________________________
Date of completion: Language of instruction – theory: _______________
4. How was the program primarily delivered? Language of instruction – clinical:________________
❏ On site — in class learning I hereby certify that to the best of my knowledge this is
❏ Online — distance learning a true statement of the record of the nursing program
❏ Other (please specify): _______________________ of the individual named in section 1 of this form.
4. Type of program
❏ Certificate Name (Please print) Title
❏ Diploma
❏ Associate Degree
❏ Baccalaureate Degree Signature Date (MM/DD/YYYY)
❏ Other (please specify): _______________________ Nursing School: Place school seal within the box
6. The program prepares graduates for practice as a: provided below
❏ Registered Nurse Mail to: College of Nurses of Ontario
❏ Registered Practical Nurse 101 Davenport Rd., Toronto, ON M5R 3P1
❏ Other (please specify): _______________________ Canada
7. Was the nursing program recognized or approved
in the jurisdiction in which the program was
completed?
❏ Yes ❏ No
Place Seal Here
FEB 2021
2021-11
