Nurse Form 2 - New York State Education Department
Social Security Number (Leave this blank if you do not have a U.S. Social Security Number) 3. Birth Date. Month . Day Year ... National council of State Boards for Nursing (NCSBN) Canadian Program Code (if applicable) ... 89 Washington Avenue, Albany, NY 12234-1000, U.S.A.OR, Submit this form to the Department by E-mail at DPLSEduc@nysed.gov. . ................
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