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Nurse 2 F

This document is a form from the New York State Education Department for applicants seeking nursing licensure who attended a foreign nursing school. It requests information about the applicant and their nursing education program. The applicant must complete Section I and have their nursing school complete Section II to verify the applicant's education details. The school must then return the entire form and an official transcript directly to the New York State Education Department for review.

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284 views2 pages

Nurse 2 F

This document is a form from the New York State Education Department for applicants seeking nursing licensure who attended a foreign nursing school. It requests information about the applicant and their nursing education program. The applicant must complete Section I and have their nursing school complete Section II to verify the applicant's education details. The school must then return the entire form and an official transcript directly to the New York State Education Department for review.

Uploaded by

Ella
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The University of the State of New York

The State Education Department


Office of the Professions
Nurse Form 2F
Division of Professional Licensing Services Certification of Foreign Nursing Education
www.op.nysed.gov

Use this form ONLY if your nursing school is located outside the United States or its territories and you were advised that CGFNS did not obtain full
documentation needed for a New York State nursing license review of your CGFNS Credentials Verification Service for New York State Application or
you are not utilizing the services of CGFNS.
Applicant Instructions
1. Complete Section I. In item 4, enter your name exactly as it appears on your Application for Licensure (Form 1). Be sure to sign and
date item 9.
2. Have the professional school you attended complete the appropriate parts of Section II. Be sure to include any fee required by the
school. The school of nursing must return the entire form in a sealed official school envelope along with an official transcript directly to
the Office of the Professions at the address at the end of this form. If the transcript is not in English, a qualified translation is also
required. For information on what constitutes a qualified translation, see our website https://www.op.nysed.gov/about/general-information-policies#verif.
This form and transcript will not be accepted if submitted by the applicant or any person or agency other than the proper school
authority.

Check what you are applying for (check one): Registered Professional Nurse Licensed Practical Nurse

Section I: Applicant Information

1. Social Security Number 2. Birth Date Month Day Year


(Leave this blank if you do not have a U.S. Social Security Number)

3. Print Name Last

First 5. Telephone/Email Address


Daytime Phone
Middle Home or Business
Licensee business address, phone and email address are public information. Failure to
indicate business or home on this form for each item will deem it public information.
Area Code Phone
4. Mailing Address Home or Business
(You must notify the Department within 30 days of any address or name changes) Email Address (please print clearly)
Home or Business
Line 1

Line 2

Line 3 6. New York State DMV ID Number


(Driver or Non-Driver ID)
City

State ZIP Code (Leave this blank if you do not have a


Country/
New York State DMV ID Number)
Province

7. Name as it appears on your Degree/Diploma/Certificate

8. Name of institution attended

Address of institution

Dates of attendance from to


mo. day yr. mo. day yr.
Title of Degree/Diploma/Certificate awarded (in original language)
Date Degree/Diploma/Certificate awarded Not yet awarded
mo. yr.

9. I request and give my permission to the institution listed in item 8 above to complete Section II of this form and mail it to the Office of the
Professions at the address at the end of this form, and to release any other information requested by the State Education Department in
connection with my application.

Signature Date

Nurse Form 2F, Page 1 of 2, Revised 3/23


Section II: Certification of Nursing Education
Instructions to the Registrar: Complete Section II to document the applicant's education. Sign and date the Certification. Return the entire
form along with an official transcript documenting completion of the program in an official school envelope directly to the Office of the
Professions at the address at the end of this form. Form 2F will not be accepted if submitted by the applicant.

Name of the applicant


(see Section I, item 7)

1. Nursing school name

Former school name

Address
(Street)

City (State/Province) (ZIP Code) (Country)

2. Nursing Program Information

Length of the program Language of instruction used

Date of admission Date of completion


mo. day yr. mo. day yr.
Years of education required for admission Date of graduation
mo. day yr.
Title of degree or diploma awarded Date degree or diploma was awarded
mo. day yr.
Type of program Baccalaureate Diploma Associate Other

This program was approved as preparing for licensed practice as a general or professional nurse or as an auxiliary/second level nurse
by:

Name of the Registration Authority who approved this program

Initial date the program was approved by the Registration Authority


mo. day yr.
If NOT approved for general nursing practice, please explain

Note: An official transcript or marksheets is issued by the school showing completed courses by year and grades and bears original school
official's signature(s) and an original school seal(s). It must be received directly from the school along with this form in a sealed official school
envelope.
Certification - To be completed by the Registrar:
I hereby certify that to the best of my knowledge and belief the information in Section II is a true statement of the record of the professional
education of the individual named on this form.

Signature of Registrar Date


Print Name

Title or official position

Institution
Institution Seal
Address

Telephone Fax Email

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Nurse Unit,
89 Washington Avenue, Albany, NY 12234-1000.
Nurse Form 2F, Page 2 of 2, Revised 3/23

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