Nurse Certification Of Education Form (Ed-Nur) - Continental Testing Services Page 2
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1
2K. NURSING SCHOOL PROGRAM CODE
NCSBN Number
SUBMISSION OF THIS FORM PRIOR TO PROGRAM COMPLETION WILL RESULT IN ITS RETURN TO THE
PROGRAM FOR CORRECTION.
I certify that the educational information recorded herein is true and correct according to the official records of this
institution.
Print Name of Dean or Director of Nursing
License Number
Signature of Dean or Director of Nursing
Date
Title
SCHOOL SEAL OR NOTARY SEAL
NOTE: If the institution does not have a school seal, this form must be notarized.
Subscribed and sworn before me this ______day of_________________, 20____.
Signature of Notary Public
Date of Expiration
RETURN THIS FORM TO APPLICANT
IL486-1031 07/04 (NS)
ED-NUR - Certification of Education - Page 2 of 2
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