Request for Verification of Registration form
[Pages:5]Request for Verification of Registration form
College of Nurses of Ontario 101 Davenport Rd., Toronto, ON M5R 3P1
Telephone: 416 928-0900 Toll-free (Canada): 1 800 387-5526 Fax: 416 928-6507
The purpose of this document is to verify to another regulatory board that you are, or were, registered with the College of Nurses of Ontario (CNO). We will not send this document to an employer or a school
Instructions
? Type your responses on this form. ? Please download the pdf form to your computer; then fill, save and email it to cno@ using the subject line "Request for
Verification of Registration Form". You can also print and fax the form to 416-928-6507.
Please review the Privacy Policy on CNO's website (privacy) to understand how your personal information will be used.
Personal Information
First name CNO Registration number Date of birth School of nursing
Regulatory board Information
Last name
Year of graduation
Street address
Telephone number Province/State
Email address
City Postal Code/Zip Code Country
Name of regulatory board to receive your verification of registration
Email address of regulatory board
Street address
City
Province/State
Postal Code/Zip Code
Country
I hereby authorize CNO to release my registration history, examination scores and any information related to my conduct and/or health that has been reviewed by CNO to the party identified above.
Signature
Fees & delivery information
Verification information will be sent directly to the identified regulatory board via email at this time
Processing fee $16.95 CAD
Total: $ __$_1__6_.9_5__
This total will be charged to your credit card.
Payment information
Payment is accepted by credit card (Visa, MasterCard, American Express). CNO does not collect payment information in writing. Please submit your completed form to CNO. Once it has been received, you will be contacted for payment by email within 10 business days. Please do not contact CNO to provide payment until we have notified you that your form has been received. Once the payment notification email has been sent, you have 30 days to make your payment or your request will be cancelled.
NOTE: Delivery by mail, fax or courier is not available at this time. Your verification information will be sent electronically; please check with the regulatory body you are applying with to ensure they accept this means of delivery.
AUG 2020
2020-72
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