cp instructions
TRANSCRIPT
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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
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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
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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
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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.
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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 -
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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.
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7/18Certifcation Program Instructions 3
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.
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8/18Certifcation Program Instructions 4
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.
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9/18Certifcation Program Instructions 5
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.
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10/18Certifcation Program Instructions 6
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 -
7/31/2019 CP Instructions
11/18Certifcation Program Instructions 7
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
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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 -
7/31/2019 CP Instructions
13/18Certifcation Program Instructions 9
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
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14/18Certifcation Program Instructions 10
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 -
7/31/2019 CP Instructions
15/18Certifcation Program Instructions 11
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
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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
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17/18Certifcation Program Instructions 13
Cardholder inormation
Cardholder name (as it appears on card)
3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA +1 (215) 222 8454 www.cgns.org
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.
3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA +1 (215) 222 8454 www.cgns.org
http://www.cgfns.org/http://www.cgfns.org/