CP Instructions

7/31/2019 CP Instructions

1/18

Nurses who have earned the CGFNS

(Certification Program) certificates

consistently have a higher rate

of success on the NCLEX-RN

examination than nurses who

have not earned certificates.

CGFNS Internationals Certiication Program is

designed specifcally or frst-level, general (registered)

nurses educated outside the United States who wish

to practice nursing in the United States. In order to be

eligible, you must have completed sucient classroom

instruction and clinical practice in

n Adult health (medical/surgical) nursing

n Maternal/Inant nursing (obstetrics), excludinggynecology

n Nursing care o children (pediatrics) and

n Psychiatric/Mental health nursing, excluding

neurology

I you have not completed a suicient number o

hours in each o the above areas, you will not be

approved to take the CGFNS Qualiying Exam

until you complete them through a government-

approved nursing school. You must also hold

an initial license/registration/diploma as a

irst-level, general nurse in your country o

education, and currently hold a license/

registration/diploma as a irst-level,

general nurse.

Revised November 2011. Copyright 20092011 CGFNS International. All rights reserved.

Certication Program Instructions


2/18Certifcation Program Instructions b

CGFNS contact inormation

CGFNS Customer Care* +1 (215) 222 8454, extension 604

Appointments* +1 (215) 222 8454, extension 221

Mailing address Suite 400, 3600 Market Street, Philadelphia, PA 19104-2651

CGFNS website www.cgns.org

CGFNS Connect https://www.cgns.org/cerpassweb/intro.jsp

Apply/Check Status https://www.cgns.org/cerpassweb/intro.jsp

Email https://www.cgns.org/cerpassweb/processContactUs.do*check sidebar on https://www.cgns.org/cerpassweb/processContactUs.do or times


3/18Certifcation Program Instructions c

Table o contents

What this booklet contains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction to the Certifcation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Credentials review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Are you a frst-level, general nurse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Do you meet the educational requirements? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Do you have appropriate license/registration/diploma documents? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

English language profciency examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Who is not required to take the examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Who is required to take the examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Contacting the examining institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Studying or the examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The CGFNS Qualiying Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Credentials review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Preparing or the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

The Ocial Study Guide for the CGFNS Qualifying Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Practice tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Question ormat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Exam dates and locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Taking the CGFNS Qualiying Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Exam results and diagnostic profle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Earning the CGFNS (Certifcation Program) certifcate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Those who do not pass the examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Apply online . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Other CGFNS services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

I your application expires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Completing the orms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The Request for Validation of License/Registration/Diploma orm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The Request for Academic Records/Transcriptsorm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

TheCGFNS Photo Identication Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

TheAuthorization to Release Informationorm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Finishing your application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Checklist to avoid processing delays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Falsifed or altered documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Submitting your application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


4/18Certifcation Program Instructions d

Communicating with CGFNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Your online account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Correspondence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

On-site appointments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Telephone calls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

In the event o a disaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Authorization to Release Inormation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Credit Card Payment Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

20092011 CGFNS International. All rights reserved. The inormation in this handbook supersedes previously released

handbooks and other documents and Web pages.


5/18Certifcation Program Instructions 1

Introduction to the Certifcation Program

What this booklet contains

1. The Certifcation Program process

n A credentials review (page 2)

n An English language profciency exam (page 3)

n The CGFNS Qualiying Exam (page 4)

n Exam results and diagnostic profle (page 6)

n Applying online (page 6)

2. Instructions or completing

n the Request for Validation of License/Registration/

Diploma orm (page 8)

n the Request for Academic Records/Transcripts orm

(page 8)

n the CGFNS Photo Identication Form (page 8 )

n theAuthorization to Release Information orm (page 8)

3. Guidelines or communicating with CGFNS (page 10)

4. TheAuthorization to Release Information orm (page 12)

5. The Credit Card Payment Form (page 13)

This instruction booklet describes how to apply or the

Certiication Program and earn a CGFNS (Certiication

Program) certiicate. There are many steps (see Table 1 on

page 7). Please read this entire booklet beore completing any

part o the application online.

CGFNS processes all applications at its headquarters in

Philadelphia, Pennsylvania, in the United States. I you

have any questions or concerns as you proceed through

the Certifcation Program, please contact CGFNS Customer

Care by the methods and during the hours shown on our

Contact Us page at https://www.cgns.org/cerpassweb/

processContactUs.do . Reer to page 10 or guidelines on

communicating with CGFNS. For more inormation on CGFNS

and its services, please visit our website at www.cgns.org.

Every year, thousands o nurses rom around the world decide

that they would like to practice as registered nurses in the

United States. The CGFNS Certifcation Program can help you

work toward your goal. The Certifcation Program is a three-

part program designed speciically or irst-level, general

nurses educated and licensed/registered outside the United

States who wish to practice nursing in the United States. Those

who are successul in the program are awarded a CGFNS

certifcate, which is good or lie.

A CGFNS certifcate assists registered nurses in three ways:

1. It helps to qualiy or an occupational visa because

it satisies the nursing examination requirement o

Section 343 o the Illegal Immigration Reorm Immigrant

Responsibility Act o 1996 and o the VisaScreen: Visa

Credentials Assessment program.

2. It helps to meet licensure and NCLEX-RN examination

eligibility requirements in many U.S. states.

3. It provides reasonable assurance o success on the NCLEX-

RN examination, because the CGFNS Qualiying Exam

uses the same test blueprint as the NCLEX. Passing the

CGFNS Qualiying Exam does not guarantee that you

will pass the NCLEX-RN examination, but nurses who have

earned CGFNS certifcates consistently have a higher rate

o success on the NCLEX than nurses who have not.

The Certifcation Program includes:

Part 1: Credentials review

CGFNS certiies that you are a irst-level, general nurse (as

defned historically by the International Council o Nurses) by

evaluating your education and license/registration/diploma.

Page 2 or more inormation.

Part 2: English language profciency examination

An English language proiciency examination is taken to

determine your understanding o English, both written andverbal. Page 3 or more inormation.

Part 3: CGFNS Qualiying Exam

The CGFNS Qual iying Exam is a one-day Internet-based

examination o your nursing knowledge. Page 4 or more

inormation.

You must successully complete all three parts o the

Certifcation Program in order to earn the CGFNS certifcate.
https://www.cgfns.org/cerpassweb/processContactUs.dohttps://www.cgfns.org/cerpassweb/processContactUs.dohttp://www.cgfns.org/http://www.cgfns.org/https://www.cgfns.org/cerpassweb/processContactUs.dohttps://www.cgfns.org/cerpassweb/processContactUs.do



Credentials review

In reviewing your eligibility or the CGFNS (Certiication

Program) certifcate, CGFNS sta give personal attention to

each application. They make decisions based on the most

current knowledge o nursing and license/registration/

diploma around the world. To ensure that all applicants are

treated airly, CGFNS reserves the right to reevaluate any

application at any point in the process, especially i we receiveadditional inormation about a jurisdictions nursing education

and registration requirements.

When CGFNS sta review your documents to determine your

eligibility or the Certifcation Program, they ask the ollowing

questions:

Are you a frst-level, general nurse?You must be educated as a frst-level, general nurse and be

licensed/registered in your country o education, as well as in

the country in which you hold a current license/registration/

diploma as a frst-level, general nurse.

n A frst-level, general nurse (as defned historically by the

International Council o Nurses) is called a registered or a

proessional nurse in some countries.

n A second-level nurse may be called an enrolled, vocational

or practical nurse or a nurse assistant. Second-level nurses

are not eligible to be licensed as registered nurses in the

United States and, thereore, can not be approved to take

the CGFNS Qualiying Exam.

n A general nurse has studied theory and has had clinical

practice in a variety o nursing areas. A nurse who

specialized in one area without being educated andlicensed/registered as a general nurse (or instance,

midwie, pediatric nurse or psychiatric nurse) will not be

approved to take the CGFNS Qualiying Exam.

Please note: Physicians and other health care proessionals

who have not completed a curriculum in an approved nursing

school are not eligible or the Certifcation Program.

Do you meet the educational requirements?CGFNS requires documents that veriy that you have:

n successully completed a secondary school education

n graduated rom a government-approved, general nursingprogram o at least two years

n received theory and clinical education in each o the

ollowing: nursing care o the adult (which includes

medical and surgical nursing), maternal/inant nursing,

nursing care o children and psychiatric/mental health

nursing

I you graduated rom a government-approved, general

nursing program, but have not had theory and clinicalpractice in one o the areas o nursing listed above,

you still may be able to meet the CGFNS requirement

by passing a nursing course in the missing area. The

course must be oered by a government-approved

school o nursing and must contain both theory and

clinical practice in the same course. Non-academic

work experience and in-service education do not meet

CGFNSs education requirement or eligibility.

I you have not completed a secondary school

education, you can meet the CGFNS secondary

education requirement by obtaining a secondary

school equivalency certifcate.

Do you have appropriate license/registration/diploma documents?

Your licensing/registration authorities must provide CGFNS

with documents veriying the ollowing:

n initial registration as a frst-level, general (registered) nurse

in the country where you completed your general nursing

education and

n current frst-level, general (registered) nurse registration

I you have previously applied or CGFNS services, and therequest or validation o your license/registration/diploma is

more than three years old, you will need to complete another

Request for Validation of License/Registration/Diploma online

and send it to your licensing authorities.

I CGFNS has questions about your documents, the respective

licensing authority may be asked to respond or provide

additional documentation so that the review o your

application can continue. Further inormation may be required

ater the initial review.

I your country does not issue a license/registration/diplomaand your nursing diploma authorizes you to practice, you must

still orward the Request for Validation of License/Registration/

Diploma orm to the issuing authority and request they

validate your diploma to ensure there has been no revocation,

suspension or restriction to practice.



English language profciency examination

Applicants applying to the Certifcation Program must pass

an English language profciency examination. The ollowing

examinations have been approved to meet the requirement:

n TOEFL PBT (Test o English as a Foreign Language Paper-

based Test)

n TOEFL iBT (Test o English as a Foreign Language Internet-

based Test)

n TOEIC (Test o English or International Communicators)

n IELTS (International English Language Testing System)

Academic Module

Who is not required to take the examinationYou may be exempt rom the English language profciency

requirement i you meet all o the ollowing criteria:

n country o nursing education was Australia, Barbados,

Canada (except Quebec: the only approved schools

in Quebec are McGill University and Dawson College

in Montreal, Vanier College in St Laurent, John AbbottCollege in Sainte-Anne-de-Bellevue and Heritage College

in Gatineau), Ireland, Jamaica, New Zealand, South Arica,

Trinidad and Tobago, the United Kingdom or the United

States and

n the language o textbooks and verbal instruction o your

education was English.

Who is required to take the examinationApplicants not exempt rom the English language profciency

examination must take and achieve a passing score on one o

the ollowing English examinations:n TOEFL-PBT or TOEFL iBT (Test o English as a Foreign

Language paper-based test or Internet-based

test), administered by the Educational Testing Service

(ETS). Passing Score: 540 (paper-based version) or 207

(computerized version) or 83 (internet-based version). For

registered nurses in the Certiication Program, only a

passing total score is required.

n TOEIC (Test o English or International Communication),

administered by ETS. Passing Score: 725.

n IELTS (International English Language Testing System)

Academic Module is jointly managed by British Council,IDP: IELTS Australia and the University o Cambridge ESOL

Examinations. Passing Score: 6.5 Overall.

The U.S. Citizenship and Immigration Services (USCIS) do not

allow the combining o scores rom dierent testing services.

It is important that you request that your English language

profciency scores are made available to CGFNS. All English

language proiciency scores are valid or two years rom

date o exam administration. You must pass both the

CGFNS Qualiying Exam and the required English languageprofciency exams within two years o each other, in any order.

All exam scores must be provided directly by the examining

institution to CGFNS. CGFNS will not accept scores orwarded

by you or anyone else. With the exception o IELTS and TOEIC,

scores are not accepted by mail.

I you took the ETS or IELTS tests in the last two years, or have

applied to take these tests, please provide CGFNS with the

exam date, and your test ETS registration number or IELTS

test report orm number as soon as possible. For TOEFL PBT

or TOEFL iBT, please reerence code number 9988 on yourapplication orm to ensure that your TOEFL results will be sent

electronically to CGFNS. For IELTS, please request that your

exam scores are made electronically available to CGFNS. For

TOEIC, please request that your scores be mailed to CGFNS.

Contacting the examining institutionsCGFNS does not make appointments or you to take the

English language proiciency examinations. Please contact

ETS or IELTS directly to make arrangements to take the

examination o your choice. For contact inormation regarding

the English exams, go to www.cgns.org/sections/programs/

cp/cp-english.shtml

Studying or the examinationTo help you become amiliar with the types o questions on

the English language profciency exam, CGFNS has included

English language practice questions in The Ocial Study Guide

for the CGFNS Qualifying Exam. English study documents also

may be obtained directly rom the testing service addresses

listed previously. You may also purchase English language

practice audio CDs rom CGFNS through your online account

at https://www.cgns.org/cerpassweb/login.jsp.



The CGFNS Qualiying Exam

Credentials reviewYou will undergo a credentials review to determine your

eligibility or the CGFNS Qualiying Exam. Thereore, send all

o your documents to CGFNS as early as possible prior to the

deadline date or the desired exam.

I, ater review o your credentials, we do not approve you or

the CGFNS Qualiying Exam, you will receive an explanation

letter. It is not unusual to ail to be approved or the exam

because o a defciency in your education. In many cases, with

urther education, applicants can become approved or the

exam.

Preparing or the examThe best way to prepare or the CGFNS Qualiying Exam is

to review what you learned in your basic nursing education

program. Study these areas: adult (medical and surgical)

nursing, Maternal/Inant nursing, nursing care o children and

psychiatric/mental health nursing. You also can beneft romreviewing the nursing process and patient needs as they are

taught in the United States (see below or inormation on the

Ocial Study Guide for the CGFNS Qualifying Examto help you

prepare or the exam).

Please note: Other than the CGFNS materials listed in this

booklet, CGFNS does not operate, license, endorse or

recommend any outside training, review, online courses,

schools or study materials that claim to prepare applicants or

the CGFNS Qualiying Exam.

The Ofcial Study Guide

or the CGFNS Qualiying ExamCGFNS has developed a study guide to help you identiy your

strengths and weaknesses in nursing knowledge. This study

guide is not a substitute or basic education or an in-depth

review o nursing textbooks. Using it does not guarantee a

passing result on the CGFNS Qualiying Exam. The sample

questions used in this guide were once actual exam questions,

but will not appear on the exam you will be taking.

The Official Study Guide for the CGFNS Qualifying Exam

includes:

n sample nursing questions with explanations o the answers

n complete examples o the CGFNS Qualiying Exam with

sample answers and explanations or correct and incorrect

answers

n a section on how to understand multiple-choice questions

n a reading list or all areas o nursing in the exam, and

n a description o the way nursing is practiced in the

United States.

The study guide will automatically be sent to you when we

receive your application and ull payment.

Practice testsThe practice tests ocus on the major client need categories

and contain questions that will enable you to gain an even

greater understanding o these specifc areas o nursing. The

ollowing practice tests are available on the CGFNS website.

Sae, Eective Care Environment practice test

The questions on the Sae, Eective Care Environment

practice test center on two main areas: management o care

and saety and inection control. The nurse must be able to

manage the care o patients in a cost-eective manner and

does so by coordinating, supervising and/or collaborating with

members o the multidisciplinary health care team. Content in

this section o the practice test will ocus on such concepts as

advocacy, advance directives, case management, client rights,

conidentiality, continuity o care, delegation, inormation

technology, legal/ethical aspects o care, quality improvement

and setting priorities.

Th e se co nd aspe ct o pr ov idin g a sa e , e e ct iv e ca re

environment is protecting clients and health care personnel

rom environmental hazards. The nurse must provide care that

prevents accidents and injuries, promotes institutional and

home saety or the client, and addresses emergency response

planning. Content in this section o the practice test will ocus

on such concepts as disaster planning, error prevention,

handling o hazardous/inectious materials, medical and

surgical asepsis, reporting o adverse incidents, sae use o

equipment, standard precautions and use o restraints and

other security devices.

Health Promotion and Maintenance practice test

The nurse assists clients and their amilies through the normal

and expected stages o growth and development rom

conception through advanced old age and provides care that

promotes the clients ability to achieve optimum health. The

questions on the Health Promotion and Maintenance practice

test emphasize promoting health, preventing illness and

detecting health problems early in the process.

Content in this practice test will ocus on such concepts

as aging, ante/intra/postpartum and newborn care,

developmental stages and transitions, body image changes,amily planning, amily systems, and human sexuality. Test

questions also will address disease prevention, health and

wellness, health promotion programs, health screening, high-

risk behaviors, immunizations, liestyle choices, sel-care and

techniques o physical assessment.

Psychosocial Integrity practice test

The questions on the Psychosocial Integrity Practice Test

center on two major areas: providing nursing care that

promotes the clients ability to cope, adapt and/or problem

solve situations related to illnesses or stressul events andmanaging and providing care or clients with acute or chronic

mental illnesses. The nurse creates a therapeutic environment

that supports the clients health and wellbeing.



Content in this practice test will ocus on such concepts as

abuse and neglect, behavioral interventions, chemical and

other dependencies, coping, crisis intervention, cultural

diversity, amily dynamics, grie and loss, religious and

spiritual inluences on health, sensory and perceptual

alterations, stress management, support systems and

therapeutic communication.

Physiological Integrity practice test

The Physiological Integrity pract ice test compris es our

sections: basic care and comort, pharmacological and

parenteral therapies, reduction o risk potential and

physiologic adaptation. The nurse provides comort and

assistance in the perormance o activities o daily living;

manages and provides care related to the administration o

medications and parenteral therapies; reduces the likelihood

that clients will develop complications or health problems

related to existing conditions, treatments or procedures; and

manages and provides care to clients with acute, chronic or

lie-threatening physical health conditions.

Content in this practice test will ocus on the ollowing areas:

Basic care and comort: assistive devices, elimination,

mobility/immobility, non-pharmacological comort

interventions, nutritional and oral hydration, personal hygiene,

and rest and sleep.

Pharmacological and parenteral therapies: Adverse eects/

contraindications/interactions, blood and blood products,

central venous access devices, chemotherapy, dosage

calculation, expected actions and outcomes, intravenous

therapy, medication administration, parenteral and

intravenous therapies, pharmacological pain managementand total parenteral nutrition.

Reduction o risk potential:Changes and abnormalities in vital

signs, diagnostic tests, laboratory values, potential alteration in

body systems, potential or complications o diagnostic tests,

treatments and procedures, potential or complications rom

surgical procedures and health alterations, system-speciic

alterations and therapeutic procedures.

Physiologic adaptation: Alterations in body systems, uid and

electrolyte imbalances, hemodynamics, illness management,

medical emergencies, pathophysiology and unexpectedresponse to therapies.

1 National Council o State Boards o Nursing. (2010). NCLEX-RN examina-

tion test plan. Chicago: NCSBN.

Question ormatMultiple-choice questions

The CGFNS Qualiying Exam is primarily a multiple-choice

examination. This means choosing a correct answer rom

several choices (see Figure 1). The multiple-choice questions

generally describe a patient, the symptoms, the treatments

or the nursing care the patient will receive. This description

contains all the inormation you need to choose thecorrect answer.

Figure 1: An example o a multiple-choice nursing question

such as those ound on the CGFNS Qualiying Exam.

Standard multiple-choice questionWhich instructions should the nurse provide when teaching apatient who was recently diagnosed with type 2 diabetes?

Possible answersA. Eat most meals at home.B. Eliminate desserts except ruit.C. Be aware o the availability o special diabetic oods.D. Maintain a regular meal schedule.

Alternate item type questions

The CGFNS Qualiying Exam also contains several alternate

item types questions that are dierent rom the single-

answer, multiple-choice ormat. Alternate item types include:

n multiple response questions that ask you to select more than

one correct answer

n hot spot questions that ask you to identiy an area on a

picture or graph

n ll in the blank questions that ask you to type in numerical

answers to calculation questions and

n drag and drop questions that ask you to order items by rank

Exam dates and locationsOnce you complete the credentials review and are approved

to take the CGFNS Qualiying Exam, you will receive an

Authorization to Testnotifcation that contains instructions on

how to schedule your examination. You will be given two test

windows o fve days each rom which to choose a date and

time or your examination.

On the day o the exam, you simply go to the location you

scheduled at the appointed time. You will be asked to present

at least two orms o identiication, one being a photo ID.

Acceptable photo IDs are passports or ocial government-

issued identifcation.

Changing your exam date ater you receive approval

I you need to change your exam date, you may do so by giving

72 hours notice beore your scheduled exam:

n to another day or time in the fve-day test window o your

originally scheduled exam, without chargen to the later fve-day test window you were given, without

charge

Taking the CGFNS Qualiying ExamThe CGFNS Qualiying Exam takes approximately three hours

to complete. Please plan your travel accordingly. I you need a

visa to travel to the exam center, apply to the proper authority

early enough to have your papers beore your departure or

the exam.

At the exam center

Please plan to arrive at the exam center at least 15 minutes

prior to your scheduled exam. I you are late, you will not be

admitted to the exam.



Family and riends are not permitted in the exam center, nor

are books, papers, cameras, calculators, tape recorders, mobile

phones or pagers. Please do not bring valuable items or large

amounts o money to the exam center. Eating or drinking will

not be allowed while the exam is in session.

When you arrive, exam center sta will ask you to sign in.

Bring two orms o identifcation, one o which is a passport

or ocial government-issued identifcation that includes your

photograph.

In the exam room, please ollow exactly the instructions that

are given to you. Rules regarding seating and behavior during

the exam must be ollowed. For example, you will be assigned

to a testing station that you may not change, a sta member

must accompany you i you leave the room and you may not

talk during the exam. No exceptions to the rules will be made.

Exam center sta will observe test takers during the exam to

make certain instructions are ollowed.

Only applicants who are oicially scheduled by CGFNS are

authorized to take the exam. Scores obtained and examssubmitted by unscheduled applicants are invalid.

Inappropriate activities

Because the CGFNS Qualiying Exam is designed to measure

your nursing knowledge, no one may give or receive help

during the exam. Inappropriate help includes getting

assistance rom anyone other than exam center sta, helping

another test taker, reerring to any printed material that could

assist you on the exam. Anyone who gives or receives such

help will be asked to leave the exam center and their exam

will not be scored. The event will be reported to CGFNS, and

the person may be barred rom taking the CGFNS QualiyingExam in the uture.

The attestation section on the application o rm in this

handbook indicates that you should not engage in any

activity that could be interpreted as alsiying, tampering

with or altering the exam. You should reuse any requests by

third parties, eg, riends, recruiters or employers to memorize

questions or give them details regarding the content o the

tests. Such activities will result in your test being oreited and

may prevent you rom being eligible or all uture exams.

I you see anyone not ollowing the rules and instructions, or i

you observe a disturbance o any kind during the exam, please

report this to the exam center supervisor at the time it occurs

or beore you leave the premises. You may also communicate

your experience by writing to the ollowing address:

CGFNS Test Administration Department

3600 Market Street, Suite 400

Philadelphia, PA 19104-2651 USA

All allegations related to inappropriate activities are taken

seriously by CGFNS and will be investigated to ensure the

integrity o the exam.

Exam results and diagnostic profleApproximately two weeks ater the fve-day test window in

which you took your exam, you may access your results in the

online account at https://www.cgns.org/cerpassweb/login.

jsp that you created when you applied or the Certifcation

Program.

The results will include a diagnostic profle with an analysis

and description o our subject areas, designated Client Need

categories:

n Sae, eective care environment

n Health promotion and maintenance

n Psychosocial integrity and

n Physiological integrity

Since these our categories orm the basis not only o

the CGFNS Qualiying Exam, but also o the NCLEX-RNexamination, knowledge o your perormance in these areas

will help to prepare you.

Earning the CGFNS(Certifcation Program) certifcateWhen you successully complete the credentials review

and pass both the CGFNS Qualiying Exam and the English

language profciency exam within two years o each other, you

will receive your CGFNS certifcate.

Those who do not pass the examinations

I you ail either the CGFNS Qualiying Exam or the Englishlanguage profciency exam you will not be awarded a CGFNS

certifcate. You will need to apply to retake each o the exams

you have ailed. Remember that both the CGFNS Qualiying

Exam and the English language profciency exam must be

passed within two years o each other.

Apply online

Only online applications will be accepted or the Certifcation

Program. You may apply online at https://www.cgns.org/

cerpassweb/intro.jsp. You may still need to mail certaindocuments (e.g., copies o secondary school education

documents). You must provide an email address in your

application because all correspondence rom CGFNS will be

electronic. You will receive your certifcate by mail.
https://www.cgfns.org/cerpassweb/intro.jsphttps://www.cgfns.org/cerpassweb/intro.jsphttps://www.cgfns.org/cerpassweb/intro.jsphttps://www.cgfns.org/cerpassweb/intro.jsp



Table 1: Overview o the process or the Certifcation Program

ACTIONS YO TAE ACTIONS CGFNS TAES

Register to create your online account. Go to https://www.cgns.org/cerpassweb/register.jsp, and fll out the inormation felds. This accountwill help keep you inormed about the status o your application, andhelp us inorm you about documents we need rom you, even i youchoose to apply through postal mail rather than online.

Apply online ater creating your user account. CGFNS sends you welcome notifcation and, ater we receive your

payment, your CGFNS ID number* electronically. We also send TheOcial Study Guide for the CGFNS Qualifying Examin PDF ormat.

Prepare and send the Request for Validation of License/Registration/Diploma orm to each licensing authority who has issued you a license/registration/diploma, including rom the country where you wereeducated, requesting that they complete the orm and directly send it toCGFNS with validation** .

Ater receiving all required documents rom you, your schools andyour licensing authorities, CGFNS reviews them. We will notiy you irequired documents or your application are missing. You can checkyour online account at https://www.cgns.org/cerpassweb/login.jspto view the status o your application.

When you successully complete the credentials review, we sendyou anAuthorization to Testnotifcation that includes schedulinginstructions and the dates o the two test windows or which you areauthorized to take the CGFNS Qualiying Exam.

Prepare and send the Request for Academic Records/Transcripts orm toyour schools, asking them to complete the orm and send your records**directly to us.

Schedule a date and time and select an exam center or your examinationollowing the instructions in yourAuthorization to Testnotifcation

Take the CGFNS Qualiying Exam. We notiy you o the results.

I you passed, move on to the next step. I you did not pass or missedyour exam, login and order a CGFNS Qualifying Exam Re-examinationapplication at https://www.cgns.org/cerpassweb/login.jsp.

Register with the examining institution and take the English languageprofciency exam. Request exam scores be orwarded or made availableelectronically to CGFNS.

CGFNS reviews the results or passing score. I you passed, moveon to the next step. I you did not pass, register and take theexam again.

You, your schools and your licensing authorities have responded toany correspondence rom CGFNS regarding missing inormation or

documents. You passed both exams within two years o each other andsuccessully completed the credentials review.

We send you your CGFNS (Certifcation Program) certifcate.

*Please note: I you applied or another CGFNS service in the past, the CGFNS ID number you were issued at that time remains your permanent ID number.

**IMPORTANT: Documents that must come directly rom your schools ocials, licensing authorities or other source agencies can be translated by themand sent directly to CGFNS in the signed, stamped and sealed envelope. Documents that you are permitted to send (such as marriage certifcates, secondaryschool diplomas) can be translated by you or anyone you choose. These translations must contain the ollowing, called the Certifcate o Accuracy, typed orwritten at the end o the translation. The translator must sign the translation.

Certifcate o Accuracy This is to certiy that this is a true and correct English translation o the attached photocopy o the original [insert name odocument] o [insert applicant name]

CGFNS can also provide translations or the ee listed at www.cgns.org/sections/apply/ees.shtml#5.

Other CGFNS services

n Document translation This is to request that CGFNS

translate your required documents into English.

n Replacement certificate This is a request to replace a

missing original CGFNS (Certifcation Program) certifcate

n Verication of certicate letter This is a request to veriy

that a CGFNS certifcate was issued

n Forwarding academic records/transcripts This is a request

or CGFNS to send copies o your oicial academic

records/transcripts to a licensing board or educational

institution (this service does NOT include an evaluation o

the documents).

n Forwarding academic records/transcripts and license/

registration/diploma/diploma This is a request or

CGFNS to send copies o both your oicial academic

records/transcripts and your oicial proessional

license/registration/diploma validations or diploma (i

it gives authorization to practice) to a licensing board or

educational institution (this service does NOT include an

evaluation o the documents).

Fees or other CGFNS services can be ound at www.cgns.org/

sections/apply/ees.shtml


12/18 8

If your application expires

You will be given 12 months to meet the credentials evaluation

expires, you can apply for the

an Expired Initial Orderand pay the fee. Reprocess applications

remain open for 12 months starting from the date the order

is placed. Reprocess applications cannot be placed until the

previous order expires.

Completing the forms

The Request for Validation ofLicense/Registration/Diplomaform

license/registration/diploma obtained outside the United

States. To do this, use the Request for Validation of License/

Registration/Diplomaform.

Complete the requested information in the applicants

section at the top of the form and send it to each licensing

authority that issued your license/registration/diploma. The

section at the bottom titled FOR LICENSING AUTHORITY TO

COMPLETE is to be completed by them. If you have a diploma

that authorized you to practice in your country, send this formto the institution that issued your diploma (for example, your

copy of the diploma in the original language be sent to CGFNS.

If we receive documents that are not in English and without

an English translation attached, we can have them translated

for the fee listed at www.cgfns.org/sections/apply/fees.shtml.

Please note: If validation of your non-U.S. license/registration/

diploma was previously mailed to us three or more years ago,

it needs to be validated again. Further information may be

required after your license/registration/diploma forms or

diplomas are reviewed.

It is a good idea to track the forms by contacting each authority

within a reasonable time after you send the forms to them.

The Request for AcademicRecords/Transcripts formTo supply us with the necessary informati on about your

education, you will need to send one copy of the Request for

Academic Records/Transcripts to each health

care post-secondary (tertiary) school that you attended outside

the United States and request they send your academic

records/transcripts directly to CGFNS. Complete the requestedinformation in the applicants section before sending it to each

school that you attended.

Request that each school complete the bottom portion of

the form entitled FOR SCHOOL TO COMPLETE. The school

needs to then enclose your academic records/transcripts and

send them directly to CGFNS. CGFNS will not process the forms

unless received directly from the school.

It is a good idea to track the forms by contacting each school

within a reasonable time after you send the forms to them.

If your academic records/transcripts are not in English, you

is

able to provide translation for a fee ( see www.cgfns.org/

sections/apply/fees.shtml).

Important note

If you receive these forms from the issuing authorities and

forward them to CGFNS, they will not be accepted, even

if unopened. We need to receive them directly, sealed,

unopened and unforwarded.

Incomplete forms will result in application processing delays.

The

Please submit to CGFNS a . We use

information and, according to the instructions at the top,

must be current, legible and signed on the front. Please submit

this form by postal mail.

TheAuthorization to Release Information formBecause CGFNS protects your privacy, your application

will only be discussed with you. If you choose to let CGFNSdisclose le information or provide le status information

to another person, you need to submit an Authorization to

Release Information form, to designate an authorized agent.

Or, if you choose to have all correspondence from CGFNS

sent to someone else, you can do this by either completing

the Authorization to Release Informat ion form or providing

the other persons mailing and email addresses on your

application form.

TheAuthorization to Release Information is valid for two years.

You can revoke the authorization at any time. CGFNS must

receive a revocation in writing by postal mail or courier service.The completed Authorization to Release Info rmat ion form

may be submitted to CGFNS with your application or mailed

separately by postal mail or delivered by courier.

Thi s form is ava ilable on the website at www.cgfns.org/

sections/apply/forms.shtml and page 16 of this booklet.

Please note: CGFNS maintains only one email and mailing

address per applicant. Therefore, if you choose to have your

correspondence from CGFNS sent to an alternative address,

correspondence meant for you, including your certicate,

will be sent there. CGFNS cannot be held responsible for anycorrespondence withheld by a third party you designated as

an authorized agent.

form
http://www.cgfns.org/files/pdf/forms/License_Registration_form.pdfhttp://www.cgfns.org/files/pdf/forms/License_Registration_form.pdfhttp://www.cgfns.org/files/pdf/forms/License_Registration_form.pdfhttp://www.cgfns.org/files/pdf/forms/AcademicRecordsFormNurses.pdfhttp://www.cgfns.org/files/pdf/forms/Photo_Identification_Form.pdfhttp://www.cgfns.org/sections/apply/forms.shtmlhttp://www.cgfns.org/sections/apply/forms.shtmlhttp://www.cgfns.org/files/pdf/forms/AcademicRecordsFormNurses.pdfhttp://www.cgfns.org/files/pdf/forms/AcademicRecordsFormNurses.pdfhttp://www.cgfns.org/files/pdf/forms/Photo_Identification_Form.pdfhttp://www.cgfns.org/files/pdf/forms/AcademicRecordsFormNurses.pdfhttp://www.cgfns.org/files/pdf/forms/License_Registration_form.pdfhttp://www.cgfns.org/sections/apply/forms.shtmlhttp://www.cgfns.org/sections/apply/forms.shtml



Finishing your application

Checklist to avoid processing delays

Beore submitting your application, check to see that you have:

completed each item on the application.

included an email address or correspondence.

sent by mail legible photocopies o your secondary school education or external exam certifcate, with literal Englishtranslation, including a Certicate of Accuracyat the end o the translation (page 7).

sent the completed Request for Validation of License/Registration/Diploma orm to each licensing agency where you

have ever held a license/registration/diploma in your feld or, in cases where your diploma authorizes legal practice,

this same orm mailed to CGFNS rom the school that issued your diploma (page 8).

sent the completed Request for Academic Records/Transcripts orm to each post-secondary (tertiary) schools (page 8).

sent the signed CGFNS Photo Identication Form with your photo signed and attached (page 8).

sent the signedAuthorization to Release Information orm, i you would like CGFNS to communicate with someone other

than yoursel (pages 8 and 12).

included ull payment through a bank check, an international money order (drawn on a United States bank in United

States dollars) made payable to CGFNS, or credit card payment (Visa, MasterCard or Discover), with the completed

Credit Card Payment form (page 13). DO NOT SEND CASH.

MUST BE SUBMITTED DIRECTLY TO CGFNS FROM OTHER AUTHORITIES:

English language profciency scores rom ETS or IELTS, i required (page 3).

Completed Request for Validation of License/Registration/Diploma orms and corresponding documents directly sent

rom all licensing authorities (page 8).

Completed Request for Academic Records/Transcripts ormsand corresponding records rom each post-secondary health

care school you attended (page 8).

Certifed translation o any documents not in English.

Please note: CGFNS does not return any o the documents that are part o your application. Please send only photocopies, notoriginals, o the documents CGFNS requests directly rom you.

Falsifed or altered documentsI CGFNS fnds that your documents have been altered in any

way, or inormation contained in your application is alsifed,

you will not be permitted to take the CGFNS Qualiying Exam.

I your documents have been altered in any way or inormation

in your application is alsiied, your application will not be

accepted, your ile will be sealed, you will lose your entire

application ee and you will not be eligible or other CGFNS

services in uture. This includes all documents and application

orms submitted by you, or on your behal by another person.

Thereore, beore anything is sent to CGFNS, make certain

that none o the documents and orms have been alsifed or

altered in any way.

Submitting your applicationAter completing any orms other than the ones to be sent

to issuing authorities, send them to CGFNS International,

along with a photocopy o your secondary school diploma

or external exam certiicate, the CGFNS Photo Identification

Form, your passport-size photos and all required ees, to the

ollowing address:

CGFNS International

3600 Market Street, Suite 400

Philadelphia, PA 19104-2651 USA



Communicating with CGFNS

Your online accountYou can apply or any o CGFNSs services online at https://

www.cgns.org/cerpassweb/intro.jsp . By creating an account

you can check your fle status, veriy receipt o documents and

scores, make changes to your contact inormation, confrm

mailing dates and access many other services all through

your browser.

I you have questions about your application or required

documents, we recommend that you check the status o

your online account at https://www.cgns.org/cerpassweb/

login.jsp. You may also contact CGFNS via letter, telephone

or through the Contact Us orm athttps://www.cgns.org/

cerpassweb/processContactUs.do. The ollowing guidelines

are provided to make this communication easier (see Table 2

on page 11 or additional inormation).

Email

You may contact CGFNS Customer Care with questionsregarding your application by email through the Contact Us

orm on our website at https://www.cgns.org/cerpassweb/

processContactUs.do

Correspondence

CGFNS policy is that your application is conidential, to be

discussed only with you. All correspondence must include your

CGFNS ID number, ull name, and birth date.

On-site appointmentsYou or your authorized agent may call +1 (215) 222 8454,

extension 221, to schedule an appointment in our oices

in Philadelphia, Pennsylvania. See the Contact Us orm

on our website at https://www.cgns.org/cerpassweb/

processContactUs.do or appointment days and times.

Telephone callsCGFNS Customer Care can provide your status inormation

by telephone. We will not release inormation by phone to

anyone other than you unless we receive a completed and

signed Authorization to Release Information orm. I you wish

to telephone us, call the Customer Care Center at +1 (215)

222 8454, extension 604. To save time, have your CGFNS IDnumber ready. I the Customer Care representative is unable

to adequately veriy your identity, inormation will not be

released by telephone.

For Customer Care Center hours, go to the Contact Us orm

at https://www.cgns.org/cerpassweb/processContactUs.

do. CGFNS Customer Care is not available weekends or U.S.

holidays, and does not accept reverse charge telephone calls.

In the event o a disasterCGFNS makes every eort to ensure that our communication

with you is straightorward and timely. However, some eventsare out o our control. Events such as natural disasters, political

unrest and postal strikes may occasionally occur. CGFNS

cannot be responsible or delays caused by such conditions,

but we will make every reasonable eort to notiy you when

this happens.

Please note: Please keep CGFNS up-to-date with any changes

in your contact inormation, especially in the atermath o a

disaster in your country.
https://www.cgfns.org/cerpassweb/processContactUs.dohttps://www.cgfns.org/cerpassweb/processContactUs.dohttps://www.cgfns.org/cerpassweb/processContactUs.dohttps://www.cgfns.org/cerpassweb/processContactUs.do



Table 2: Communication guidelines

RESNS FR CNICIN

W CN

INIIE REqES? CNICIN CNNELS SPECIL IPS

You want to confrm that yourapplication documents havebeen received by CGFNS orthat you have been scheduledor an exam

Only you oryour authorizedagent

Telephone or check your status at https://www.cgns.org/cerpassweb/intro.jsp or email CGFNS

through the Contact Us orm at https://www.

cgns.org/cerpassweb/processContactUs.do

Include your ull name, CGFNS IDnumber and birth date

You have a question about

a letter that you receivedrom CGFNS

Only you or

your authorizedagent

Telephone, make an oce appointment or email

CGFNS through the Contact Us orm at https://www.cgns.org/cerpassweb/processContactUs.do

Include your ull name, CGFNS ID

number and birth date

You need to notiy CGFNSo your address change

Only you oryour authorizedagent

Make the changes in your online account athttps://www.cgns.org/cerpassweb/login.jsp

or email through the Contact Us orm at https://

www.cgns.org/cerpassweb/processContactUs.do

Include your ull name, CGFNS IDnumber and birth date

You want to order a study aidor other item

Anyone Order through your online account at https://www.cgns.org/cerpassweb/login.jsp

Enter the name and address ordelivery o the study aids and pay theappropriate ee

You want CGFNS tosend verifcation o yourcertifcate status

Only you Place an order through your online account athttps://www.cgns.org/cerpassweb/login.jsp ormail a written request

State the request and to whomthe letter should be sent. Includeyour CGFNS ID number, birth date,signature, and pay the appropriate eeat https://www.cgns.org/cerpassweb/

intro.jsp

You want CGFNS to maila copy o your nursingeducation inormation toa school or U.S. board onursing

Only you Place an order through your online account athttps://www.cgns.org/cerpassweb/login.jsp ormail a written request

State the recipient o your educationinormation. Include your CGFNS IDnumber, birth date and proo o namechange (i applicable), sign and mailthe appropriate ee or pay online athttps://www.cgns.org/cerpassweb/intro.jsp

You want to scheduleor change your CGFNSQualiying Exam dateor location

Only you Follow instructions within yourAuthorization toTestnotifcation

You wish to report a legal

name change

Only you Write to CGFNS including name change

documentation at Suite 400, 3600 Market Street,Philadelphia, PA 19104-2651 USA

Request should include signature,

CGFNS ID number and birth date



Authorization to Release Inormation

NOTICE: By signing below you (1) allow CGFNS to disclose confdential, personal, private inormation about you and your fle

at CGFNS to the person designated below; (2) give up the right to receive inormation rom CGFNS directly; and (3) release and

indemniy CGFNS, its members, trustees, ocers and employees rom any liability or losses, damages or claims o any type arising

out o actions taken by CGFNS in reliance upon thisAuthorization to Release Information, hereater known as Authorization.

This Authorization will remain valid or two years rom the date supplied by you on the Date line below (or i no date is supplied,

rom the date this Authorization is received by CGFNS).

REVOCATION: This Authorization can be revoked by submitting a new authorization dated and signed ater the initial

authorization. In addition, you may revoke this Authorization in writing at any time, which will be eective on or ater the 30th

day ater CGFNS receives it, by regular mail or courier, at its headquarters oce in Philadelphia, Pennsylvania, USA.

ATHORIZATION: I authorize CGFNS to release to the authorized agent indicated by me below, any and all inormation about

me and my application/order or services rom CGFNS, including, and without limitation, the status o my application/order, the

results o any credentials review, examination or test and any other inormation in or relating to my fle at CGFNS. I understand

that all mail (including certifcates, exam scores and reports) will be sent to the authorized agent.

This authorization revokes all previous authorizations submitted by the applicant.

Your CGFNS ID number (i known) Your birth date (spell the month and enter numbers or the day and year)

Month Day Year

1 2

Your signature

Your signature Date / /Do not print Month Day Year

Print your name

3

Your authorized agent (please print)

Your contacts name

The organization your contact is representing

Your contacts address

Day telephone Fax

Evening telephone Email

4

3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA +1 (215) 222 8454 www.cgns.org



Cardholder inormation

Cardholder name (as it appears on card)


Please type or print legibly.To pay by credit card, please fll in below your name as it appears in your application/order and your

CGFNS ID number (i known). Complete the cardholder inormation as requested.

Applicant name1

First (given) and middle names (leave a space between n ames)

Last (amily/surname) names (leave a space between names)

CGFNS ID number (i known)2 Applicant birth date (spell the month and enter numbers or the day and year)

Month Day Year

3

4

First name, middle initial and last name (leave a space between names)

Credit card number CVV2 number* (see below or explanation)

Expiration date Month Year Total chargesUS $

(see ees page online athttp://www.cgns.org/sections/apply/ees.shtml)

*Explanation o credit card CVV2 number

Visa and MasterCard: This number is printed in the signature area on the back o the card (they

are the last 3 digits ater the credit card number).

Credit card type(check one) nVisa nMastercard nDiscover

Cardholder address (or processing credit card payments only)

Street

Street

City State/Province

Post/Zip code Country

Cardholder signature (authorization or payment)

I hereby authorize a charge to my credit card or the total o all services ordered in this application

including any ee adjustments in eect as o the date the order is received.

Signature o authorized cardholder

5
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CGFNS issionTo serve the global community through programs and services that veriy and promote

the knowledge-based practice competency o health care proessionals.

http://www.cgfns.org/http://www.cgfns.org/

CP Instructions

Documents

Transcript of CP Instructions